Healthcare Provider Details

I. General information

NPI: 1457175390
Provider Name (Legal Business Name): FORTUNATE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7006 E FISH LAKE RD
MAPLE GROVE MN
55311-2832
US

IV. Provider business mailing address

7006 E FISH LAKE RD
MAPLE GROVE MN
55311-2832
US

V. Phone/Fax

Practice location:
  • Phone: 952-994-5356
  • Fax: 952-674-7774
Mailing address:
  • Phone: 952-994-5356
  • Fax: 952-674-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SUSAN NYANG'ANYI OBWAYA
Title or Position: OWNER/CEO
Credential:
Phone: 952-994-5356