Provider Demographics
NPI:1023096476
Name:CHASKA QUALITY CARE LLC
Entity type:Organization
Organization Name:CHASKA QUALITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:YASIN
Authorized Official - Last Name:SUFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-446-5480
Mailing Address - Street 1:1107 HAZELTINE BLVD STE 484
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1065
Mailing Address - Country:US
Mailing Address - Phone:612-446-5480
Mailing Address - Fax:612-446-5286
Practice Address - Street 1:1107 HAZELTINE BLVD STE 484
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1065
Practice Address - Country:US
Practice Address - Phone:612-446-5480
Practice Address - Fax:612-446-5286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN457403600Medicaid
MN20616OtherMN CLASS A
MN457403600Medicaid