MEDICARE: EJ HAVEN 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1356132674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJ HAVEN LLC

Provider Business Mailing Address
First Line	:	5139 HUMBOLDT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-3426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5139 HUMBOLDT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-3426
Country	:	US
Telephone Number	:	763-568-9519
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IDOWU OLUSEGUN OBAZELUWA
Credential	:
Telephone Number	:	763-568-9519

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

Similar Medicare Providers

1205799392 — RYAN KARJALAHTI
Practice Location Address:

4147 38TH AVE S
MINNEAPOLIS, MN
55406-3426

Practice Phone: 612-708-8998
Practice Fax:

1477541282 — AMERICAN BAPTIST HOMES OF THE MIDWEST
Practice Location Address:

512 49TH AVE N
MINNEAPOLIS, MN
55430-3621

Practice Phone: 612-529-7747
Practice Fax: 612-529-5643

1083637474 — DR. JOSHUA RIFF MD
Practice Location Address:

1000 NICOLLET MALL , TPS 17-97
MINNEAPOLIS, MN
55430

Practice Phone: 612-696-3043
Practice Fax:

1255424115 — LONG TERM CARE SPECIALISTS INC
Practice Location Address:

512 49TH AVE N
MINNEAPOLIS, MN
55430-3621

Practice Phone: 612-529-7747
Practice Fax: 612-607-5821

1306912282 — REM HENNEPIN, INC.
Practice Location Address:

6200 SHINGLE CREEK PKWY STE 580
MINNEAPOLIS, MN
55430-2170

Practice Phone: 763-852-5325
Practice Fax:

1417013152 — E & E HOME CARE INC
Practice Location Address:

523 49TH AVE N
MINNEAPOLIS, MN
55430-3620

Practice Phone: 612-599-7750
Practice Fax: 612-588-7732

Directions to “EJ HAVEN LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.