Healthcare Provider Details

I. General information

NPI: 1679350425
Provider Name (Legal Business Name): FORTUNATE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5738 33RD AVE S
MINNEAPOLIS MN
55417-2857
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: 952-674-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

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