Provider Demographics
NPI:1598955288
Name:21ST CENTURY CARE OF MINNESOTA LLC
Entity Type:Organization
Organization Name:21ST CENTURY CARE OF MINNESOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-216-0888
Mailing Address - Street 1:416 E HENNEPIN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1006
Mailing Address - Country:US
Mailing Address - Phone:612-216-0888
Mailing Address - Fax:
Practice Address - Street 1:416 E HENNEPIN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1006
Practice Address - Country:US
Practice Address - Phone:612-216-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-28
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN433645000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health