Organization
PREMIUM CHOICE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FERDINAND MBAANIK FONDO (MANAGER)
(651) 239-6149
Entity
Organization
Contact information
Practice address
1983 GENEVA AVE N STE 1983, OAKDALE, MN 55128-4108
(651) 239-6149
(651) 772-3357
Mailing address
1949 GENEVA AVE N STE 1983, OAKDALE, MN 55128-4108
(651) 239-6149
(651) 772-3357
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
698669300020
MN
Other
Enumeration date
09/13/2013
Last updated
11/12/2019
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