Provider Demographics
NPI:1487067153
Name:CLIENT CENTERED CARE
Entity type:Organization
Organization Name:CLIENT CENTERED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:BRADLY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN CRRN
Authorized Official - Phone:651-600-3869
Mailing Address - Street 1:393 DUNLAP STREET NORTH
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-600-3869
Mailing Address - Fax:651-797-4308
Practice Address - Street 1:393 DUNLAP ST N
Practice Address - Street 2:SUITE 105
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4200
Practice Address - Country:US
Practice Address - Phone:651-600-3869
Practice Address - Fax:651-797-4308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLIENT CENTERED HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home