Green Lakes LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

GREEN LAKES LLC

Practice address

277 Coon Rapids Blvd NW Ste 414
Coon Rapids, MN 55433-5865

Phone

(612) 888-5040

Fax

(612) 688-7440

NPI assigned

Jan 23, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Folarin Adedeji

Title

Director of Operations

Phone

(612) 888-5040

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1275123200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 COON RAPIDS BLVD NW STE 414",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335865",
            "telephone_number": "612-888-5040",
            "fax_number": "612-688-7440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 COON RAPIDS BLVD NW STE 414",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335865",
            "telephone_number": "612-888-5040",
            "fax_number": "612-688-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LAKES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-23",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "ADEDEJI",
        "authorized_official_first_name": "FOLARIN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "612-888-5040"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.