Provider Demographics
NPI:1700652880
Name:SHEKKY CARE SERVICES PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHEKKY CARE SERVICES PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUGBENGA
Authorized Official - Middle Name:OLALELEKAN
Authorized Official - Last Name:BANJO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:651-210-9638
Mailing Address - Street 1:1160 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:ST PAUL PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55071-1344
Mailing Address - Country:US
Mailing Address - Phone:651-210-9638
Mailing Address - Fax:
Practice Address - Street 1:1160 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:ST PAUL PARK
Practice Address - State:MN
Practice Address - Zip Code:55071-1344
Practice Address - Country:US
Practice Address - Phone:651-210-9638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness