Provider Demographics
NPI:1205376639
Name:UNIVERSAL ADULT DAY CARE CENTER, LLC.
Entity Type:Organization
Organization Name:UNIVERSAL ADULT DAY CARE CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOUNEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-999-4788
Mailing Address - Street 1:7322 LAKELAND AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1228
Mailing Address - Country:US
Mailing Address - Phone:763-999-4788
Mailing Address - Fax:763-999-4789
Practice Address - Street 1:7322 LAKELAND AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1228
Practice Address - Country:US
Practice Address - Phone:763-999-4788
Practice Address - Fax:763-999-4789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL ADULT DAY CARE CENTER, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-04
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1081612-1-ADC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1081612-1-ADCOtherADULT DAY CARE CENTER