Provider Demographics
| NPI: | 1942029871 |
|---|---|
| Name: | CARE GROVE SERVICES LLC |
| Entity type: | Organization |
| Organization Name: | CARE GROVE SERVICES LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/ CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | GURANIE |
| Authorized Official - Middle Name: | BLAMA |
| Authorized Official - Last Name: | KANNEH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 612-309-4477 |
| Mailing Address - Street 1: | 3815 BURQUEST LN |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BROOKLYN CENTER |
| Mailing Address - State: | MN |
| Mailing Address - Zip Code: | 55429-3028 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 612-309-4477 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 3815 BURQUEST LN |
| Practice Address - Street 2: | |
| Practice Address - City: | BROOKLYN CENTER |
| Practice Address - State: | MN |
| Practice Address - Zip Code: | 55429-3028 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 612-309-4477 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-10-08 |
| Last Update Date: | 2024-10-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
| No | 251B00000X | Agencies | Case Management | |
| No | 251E00000X | Agencies | Home Health | |
| No | 251F00000X | Agencies | Home Infusion | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
| No | 374U00000X | Nursing Service Related Providers | Home Health Aide | |
| No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
