Organization
AGLOW HEALTHCARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRINCESS KOU GEHYIGON-WALLACE NP (OWNER)
(763) 913-8125
Entity
Organization
Contact information
Practice address
6626 RED BIRCH CT, LINO LAKES, MN 55014-1337
(763) 913-8125
Mailing address
PO BOX 152, LINO LAKES, MN 55014-0152
(763) 913-8125
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251E00000X
Home Health Agency
Primary
—
—
251F00000X
Home Infusion Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
07/06/2022
Last updated
07/06/2022
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