| Kesma Flame Lily Llc | |
|
2800 Freeway Blvd Ste 204/7 Minneapolis MN 55430-5543 | |
| (612) 408-7733 | |
| (763) 292-5653 |
| Full Name | Kesma Flame Lily Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2800 Freeway Blvd, Minneapolis, Minnesota |
| Authorized Official Name and Position | Petronellah Thoko Thomas-shanobi (CEO/CLINICAL DIRECTOR) |
| Authorized Official Contact | 6124087733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kesma Flame Lily Llc 20705 Otero Ave Hastings MN 55033-9600 Ph: (612) 408-7733 | Kesma Flame Lily Llc 2800 Freeway Blvd Ste 204/7 Minneapolis MN 55430-5543 Ph: (612) 408-7733 |
| NPI Number | 1295212355 |
|---|---|
| Provider Enumeration Date | 07/22/2018 |
| Last Update Date | 09/25/2023 |
| Certification Date | 09/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295212355 | NPI | - | NPPES |
| 0000000 | Other | MN | BEHAVIORAL HEALTH |
| 6744924000 | Medicaid | MN |
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