Provider Demographics
NPI:1467142984
Name:PLATEAU PCA SERVICES LLC
Entity Type:Organization
Organization Name:PLATEAU PCA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:FAISALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUKARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-444-1361
Mailing Address - Street 1:8848 ZEALAND AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1864
Mailing Address - Country:US
Mailing Address - Phone:763-444-1361
Mailing Address - Fax:763-444-1358
Practice Address - Street 1:8848 ZEALAND AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-1864
Practice Address - Country:US
Practice Address - Phone:763-444-1361
Practice Address - Fax:763-444-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health