Healthcare Provider Details

I. General information

NPI: 1598132086
Provider Name (Legal Business Name): ELIZJOSEPH HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 FREEWAY BLVD STE 100
BROOKLYN CENTER MN
55430-1751
US

IV. Provider business mailing address

2800 FREEWAY BLVD STE 100
BROOKLYN CENTER MN
55430-1751
US

V. Phone/Fax

Practice location:
  • Phone: 612-501-4029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHFID 31880
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAMILOLA AGUNBIADE
Title or Position: ADMIN
Credential:
Phone: 612-886-9404