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NPI Code Detail

MEDICARE: KESMA FLAME LILY LLC

MEDICARE: KESMA FLAME LILY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/Center
2251E00000XHome Health Agency
3101YM0800XMental Health Counselor
4261QM1000XMigrant Health Clinic/Center
5251S00000XCommunity/Behavioral Health Agency
6261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
7252Y00000XEarly Intervention Provider Agency
8101YP2500XProfessional Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000000OTHERMNBEHAVIORAL HEALTH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295212355
Entity Type Code : Organization
Provider Name (Legal Business Name) : KESMA FLAME LILY LLC
Provider Business Mailing Address
First Line : 20705 OTERO AVE
Second Line :
City : HASTINGS
State : MN
Zip : 55033-9600
Country : US
Telephone Number : 612-408-7733
Fax Number : 763-292-5653
Provider Business Practice Location Address
First Line : 7030 BROOKLYN BLVD STE 2047
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55429-1370
Country : US
Telephone Number : 612-408-7733
Fax Number : 763-292-5653
Authorized Official
Title or Position : CEO/CLINICAL DIRECTOR
Name : PETRONELLAH THOKO BENSEN
Credential : LPCC
Telephone Number : 612-408-7733
Provider Enumeration Date : 07/22/2018
Last Update Date : 09/06/2025

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Directions to “KESMA FLAME LILY LLC ” Practice Location

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