Great Lake Care LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GREAT LAKE CARE LLC

Practice address

1710 Douglas Dr N Ste 224E
Golden Valley, MN 55422-4350

Phone

(763) 221-2102

NPI assigned

Aug 5, 2020

Organization subpart

No

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

Authorized official

Name

Ifrah ElmiNPI 1952128902

Title

Ceo

Phone

(763) 221-2102

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ifrah Elmi

  • Psychiatric/Mental Health Nurse Practitioner
  • Golden Valley, MN
  • NPI 1952128902
  NPD Authorized official

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1356951255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7549 EMERSON AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554442539",
            "telephone_number": "763-221-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 DOUGLAS DR N STE 224E",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224350",
            "telephone_number": "763-221-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-05",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "ELMI",
        "authorized_official_first_name": "IFRAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-221-2102"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6931842",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "WWW.GREATLAKECARE.COM",
            "affiliation": "N",
            "address_1": "1710 Douglas Dr N Ste 224E",
            "city": "Golden Valley",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554224350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Teresa Mary Graham, LICSW
• Todd Fleming Grant, MD
• Maryjo Graske, LMFT
• Lauren E Graveline, COTA/L
• Gregory Allen Gray, LMFT
• Greater Minneapolis Crisis Nursery
• Rachel Greene, LMFT
• Jodi Lynn Greenstein, LICSW
• Allison B Greenwald, MSW, LCSW
• Kelly Gregory, DPT

• Community/Behavioral Health Agency in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; 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.