Provider Demographics
NPI:1043986409
Name:MYSKYE CARE
Entity Type:Organization
Organization Name:MYSKYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-398-1996
Mailing Address - Street 1:4324 MARIGOLD AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1546
Mailing Address - Country:US
Mailing Address - Phone:612-226-5766
Mailing Address - Fax:612-500-4330
Practice Address - Street 1:7671 CENTRAL AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3542
Practice Address - Country:US
Practice Address - Phone:651-398-1996
Practice Address - Fax:612-500-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA196600700Medicaid
MNA550031400Medicaid