Healthcare Provider Details

I. General information

NPI: 1093677577
Provider Name (Legal Business Name): DESIRE HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 24TH AVE S
GRAND FORKS ND
58201-6122
US

IV. Provider business mailing address

2951 24TH AVE S
GRAND FORKS ND
58201-6122
US

V. Phone/Fax

Practice location:
  • Phone: 701-610-5057
  • Fax: 701-610-5057
Mailing address:
  • Phone: 701-610-5057
  • Fax: 701-610-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OORE-OFE BLESSING BABATUNDE
Title or Position: OWNER
Credential:
Phone: 701-610-5057