Provider Demographics
NPI:1912886938
Name:NORTHSTAR RESIDENTIAL CARE INC.
Entity type:Organization
Organization Name:NORTHSTAR RESIDENTIAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEMACHU
Authorized Official - Middle Name:
Authorized Official - Last Name:RABU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-439-1797
Mailing Address - Street 1:1217 88TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1217 88TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1326
Practice Address - Country:US
Practice Address - Phone:763-439-1797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility