# LAKE TOWN HOMECARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Town HomeCare, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275049116
- **Authorized official:** YASMIN YUSUF (CEO/ PRESIDENT)
- **Authorized official phone:** (619) 892-1613

## Contact information

- **Practice address:** 4119 SCOTT AVE N, ROBBINSDALE, MN 55422
- **Practice address phone:** (619) 892-1613
- **Mailing address:** 2121 NICOLLET AVE S SUITE 6, MINNEAPOLIS, MN 55404
- **Mailing address phone:** (619) 246-0239

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 12/14/2017
- **Last updated:** 05/15/2018