Healthcare Provider Details

I. General information

NPI: 1851217327
Provider Name (Legal Business Name): LILY OF THE VALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8934 GRENADIER AVE S
COTTAGE GROVE MN
55016-2779
US

IV. Provider business mailing address

8934 GRENADIER AVE S
COTTAGE GROVE MN
55016-2779
US

V. Phone/Fax

Practice location:
  • Phone: 952-846-7885
  • Fax: 651-432-9458
Mailing address:
  • Phone: 952-846-7885
  • Fax: 651-432-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: IFEOMA AMAIKWU-CLEY
Title or Position: OWNER
Credential:
Phone: 952-846-7885