MEDICARE: GUIDING LIGHTS SERVICE 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	:	1467273763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING LIGHTS SERVICE LLC

Provider Business Mailing Address
First Line	:	111 MARQUETTE AVE APT 2309
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2033
Country	:	US
Telephone Number	:	218-979-1007
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MARQUETTE AVE APT 2309
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2033
Country	:	US
Telephone Number	:	218-979-1007
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADEBIMPE OLAWUNMI OLATEJU
Credential	:
Telephone Number	:	218-979-1007

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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