| Great Lake Care Llc | |
|
1710 Douglas Dr N Ste 224e Golden Valley MN 55422-4350 | |
| (763) 221-2102 | |
| Not Available |
| Full Name | Great Lake Care Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1710 Douglas Dr N Ste 224e, Golden Valley, Minnesota |
| Authorized Official Name and Position | Ifrah Elmi (CEO) |
| Authorized Official Contact | 7632212102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lake Care Llc 7549 Emerson Ave N Brooklyn Park MN 55444-2539 Ph: (763) 221-2102 | Great Lake Care Llc 1710 Douglas Dr N Ste 224e Golden Valley MN 55422-4350 Ph: (763) 221-2102 |
| NPI Number | 1356951255 |
|---|---|
| Provider Enumeration Date | 08/05/2020 |
| Last Update Date | 08/05/2020 |
| Certification Date | 08/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356951255 | NPI | - | NPPES |
| 6931842 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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