Organization
GLORIOUS EAGLES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. SAMSON ALAYANDE (PRESIDENT)
(612) 456-6090
Entity
Organization
Contact information
Practice address
2119 110TH LN NW, COON RAPIDS, MN 55433-4173
(612) 456-6090
Mailing address
2119 110TH LN NW, COON RAPIDS, MN 55433-4173
(612) 456-6090
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
01/09/2023
Last updated
08/12/2023
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