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General NPI Number Information
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NPI Number | 1841054707
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Entity Type | Organization
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Legal Business Name | HOUSE OF GILEAD LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 1133 126TH LN NE
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City | BLAINE
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State | MN
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Zip | 55434-4007
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Country | US
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Telephone | 763-352-1684
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Fax | 651-212-4891
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Provider Business Mailing Address
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Address Line | 1401 SILVER LAKE RD NW STE 7
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-9307
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Country | US
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Telephone | 763-352-1684
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Fax | 651-212-4891
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Authorized Official
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Title or Position | OWNER
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Name | JULIANA NWAKAEGO OKORO
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Credential | RN
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Telephone | 763-352-1684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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