Provider Demographics
NPI:1134431802
Name:PLATEAU HEALTHCARE LLC
Entity type:Organization
Organization Name:PLATEAU HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAISALE
Authorized Official - Middle Name:SALE
Authorized Official - Last Name:BOUKARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-444-1361
Mailing Address - Street 1:8848 ZEALAND AVE N STE B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1891
Mailing Address - Country:US
Mailing Address - Phone:763-444-1361
Mailing Address - Fax:763-444-1358
Practice Address - Street 1:6424 JUNE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2127
Practice Address - Country:US
Practice Address - Phone:763-444-1361
Practice Address - Fax:763-444-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN352764251E00000X, 251J00000X
MN353611253Z00000X
310400000X
MN372551251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility