Provider Demographics
NPI:1700186327
Name:FORGET-ME-NOT HEALTH SERVICES
Entity Type:Organization
Organization Name:FORGET-ME-NOT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-522-0355
Mailing Address - Street 1:1012 MORGAN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3803
Mailing Address - Country:US
Mailing Address - Phone:612-522-0355
Mailing Address - Fax:
Practice Address - Street 1:6000 BASS LAKE RD
Practice Address - Street 2:STE. 201
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2700
Practice Address - Country:US
Practice Address - Phone:763-447-7258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health