Provider Demographics
NPI:1487475794
Name:KAYO HEALTH CARE CENTER LLC
Entity type:Organization
Organization Name:KAYO HEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ZERITU
Authorized Official - Middle Name:WOYESA
Authorized Official - Last Name:MUTAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-309-8940
Mailing Address - Street 1:5941 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5530
Mailing Address - Country:US
Mailing Address - Phone:612-309-8940
Mailing Address - Fax:
Practice Address - Street 1:5941 6TH ST NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5530
Practice Address - Country:US
Practice Address - Phone:612-309-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility