Organization
GREAT LAKE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IFRAH ELMI (CEO)
(763) 221-2102
Entity
Organization
Contact information
Practice address
1710 DOUGLAS DR N STE 224E, GOLDEN VALLEY, MN 55422-4350
(763) 221-2102
Mailing address
7549 EMERSON AVE N, BROOKLYN PARK, MN 55444-2539
(763) 221-2102
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6931842
—
MN
Enumeration date
08/05/2020
Last updated
08/05/2020
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