Provider Demographics
NPI:1376774687
Name:ULTIMATE CARE GROUP, INC
Entity Type:Organization
Organization Name:ULTIMATE CARE GROUP, INC
Other - Org Name:IMANI ROCK HEALTH SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:APATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-560-9890
Mailing Address - Street 1:7040 LAKELAND AVE N
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-5600
Mailing Address - Country:US
Mailing Address - Phone:763-560-9890
Mailing Address - Fax:763-560-9891
Practice Address - Street 1:7040 LAKELAND AVE N
Practice Address - Street 2:SUITE 208
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-5600
Practice Address - Country:US
Practice Address - Phone:763-560-9890
Practice Address - Fax:763-560-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCLASS A 343995251E00000X
MNCLASS F348031320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA866615100Medicaid
MNM007903000Medicaid
MNA418610000Medicaid