Provider Demographics
NPI:1730392713
Name:FAMILY QUALITY CARE, INC
Entity type:Organization
Organization Name:FAMILY QUALITY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMINA
Authorized Official - Middle Name:ROBLE
Authorized Official - Last Name:GESALE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:612-353-5785
Mailing Address - Street 1:2612 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408
Mailing Address - Country:US
Mailing Address - Phone:612-353-5785
Mailing Address - Fax:612-886-3584
Practice Address - Street 1:2612 1ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:612-353-5785
Practice Address - Fax:612-886-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333004251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM407175100Medicare UPIN