Provider Demographics
NPI:1396039194
Name:ULTIMATE GOAL HOME CARE AGENCY INC
Entity Type:Organization
Organization Name:ULTIMATE GOAL HOME CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ETCHIBANYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-725-0560
Mailing Address - Street 1:3300 COUNTY ROAD 10 STE 400B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3067
Mailing Address - Country:US
Mailing Address - Phone:763-458-1548
Mailing Address - Fax:763-431-7333
Practice Address - Street 1:3300 COUNTY ROAD 10 STE 400B
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3067
Practice Address - Country:US
Practice Address - Phone:763-458-1548
Practice Address - Fax:763-431-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health