Organization
GJ DESTINY ADULT FOSTER HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIRGINIA ANN PUFAHL (OWNER/DIRECTOR)
(320) 692-4790
Entity
Organization
Contact information
Practice address
14295 82ND ST NE, OTSEGO, MN 55330-6812
(320) 692-4790
Mailing address
14295 82ND ST NE, OTSEGO, MN 55330-6812
(320) 692-4790
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
1055022 1 AFC
MN
Other
Enumeration date
08/04/2009
Last updated
08/04/2009
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