Healthcare Provider Details

I. General information

NPI: 1225956527
Provider Name (Legal Business Name): GREATER HEIGHTS HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 24TH ST S APT 111
SAINT CLOUD MN
56301-8918
US

IV. Provider business mailing address

4005 24TH ST S APT 111
SAINT CLOUD MN
56301-8918
US

V. Phone/Fax

Practice location:
  • Phone: 612-919-1605
  • Fax:
Mailing address:
  • Phone: 612-919-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH A OTUNUGA
Title or Position: OWNER
Credential:
Phone: 612-919-1605