Provider Demographics
NPI:1992450324
Name:CHEZ MICHAEL CARE LLC
Entity type:Organization
Organization Name:CHEZ MICHAEL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-888-3515
Mailing Address - Street 1:3300 COUNTY ROAD 10 STE 300B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3066
Mailing Address - Country:US
Mailing Address - Phone:269-873-0690
Mailing Address - Fax:800-966-2364
Practice Address - Street 1:5748 REGENT AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2815
Practice Address - Country:US
Practice Address - Phone:269-873-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances