Organization
GREEN LAKES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FOLARIN ADEDEJI (DIRECTOR OF OPERATIONS)
(612) 888-5040
Entity
Organization
Contact information
Practice address
277 COON RAPIDS BLVD NW STE 414, COON RAPIDS, MN 55433-5865
(612) 888-5040
(612) 688-7440
Mailing address
277 COON RAPIDS BLVD NW STE 414, COON RAPIDS, MN 55433-5865
(612) 888-5040
(612) 688-7440
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/23/2021
Last updated
10/14/2021
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