Provider Demographics
NPI:1053944165
Name:QUALICARE HOMES CORPORATION
Entity type:Organization
Organization Name:QUALICARE HOMES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AFOLABI
Authorized Official - Middle Name:OLUMUYIWA
Authorized Official - Last Name:OSIBERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-324-8220
Mailing Address - Street 1:7026 104TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2692
Mailing Address - Country:US
Mailing Address - Phone:763-324-8220
Mailing Address - Fax:763-324-8250
Practice Address - Street 1:950 121ST LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-2139
Practice Address - Country:US
Practice Address - Phone:763-324-8220
Practice Address - Fax:763-324-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health