GREEN LAKES LLC NPI 1275123200

NPI Details

GREEN LAKES LLC is a home health in Coon Rapids, MN. The provider is a public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. GREEN LAKES LLC NPI is 1275123200. The provider is registered as an organization entity type.

The provider's business location address is:

277 COON RAPIDS BLVD NW STE 414
COON RAPIDS, MN
ZIP 55433-865
Phone: (612) 888-5040
Fax: (612) 688-7440

The provider's authorized official is Folarin Adedeji .
The authorized official title is Director Of Operations and has the following contact phone number (612) 888-5040.

The CLIA number assigned to this NPI record is 24D2288568 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/23/2021 and was last updated on 10/14/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available: