Provider Demographics
NPI:1659490753
Name:ESTEEM NURSING CARE, INC
Entity Type:Organization
Organization Name:ESTEEM NURSING CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OKIDEGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-503-2400
Mailing Address - Street 1:3300 BASS LAKE ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3072
Mailing Address - Country:US
Mailing Address - Phone:763-503-2400
Mailing Address - Fax:763-503-2401
Practice Address - Street 1:3300 BASS LAKE ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3072
Practice Address - Country:US
Practice Address - Phone:763-503-2400
Practice Address - Fax:763-503-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331994251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN399493Medicaid