Provider Demographics
NPI:1972283703
Name:MEDIAN COMMUNITY AND CARE LLC
Entity Type:Organization
Organization Name:MEDIAN COMMUNITY AND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:OKINDO
Authorized Official - Last Name:MAKIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-433-4255
Mailing Address - Street 1:20465 AKIN CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-1047
Mailing Address - Country:US
Mailing Address - Phone:612-220-0556
Mailing Address - Fax:
Practice Address - Street 1:20465 AKIN CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1047
Practice Address - Country:US
Practice Address - Phone:612-220-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility