Provider Demographics
NPI:1265773261
Name:CARELEGACY PCA AGENCY, INC
Entity type:Organization
Organization Name:CARELEGACY PCA AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINBOWALE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BARBINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:763-561-1439
Mailing Address - Street 1:6901 78TH AVE N STE 101B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2720
Mailing Address - Country:US
Mailing Address - Phone:763-561-1439
Mailing Address - Fax:763-566-4793
Practice Address - Street 1:6901 78TH AVE N STE 101B
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2720
Practice Address - Country:US
Practice Address - Phone:763-561-1439
Practice Address - Fax:763-566-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health