| NPI | 1649914375 |
|---|---|
| Doing Business As | GREAT LAKES VILLA |
| Entity Type | Organization |
| Authorized Contact | DEBORAH A OJOGWU Owner/Manager 952-210-2817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2023-04-12 |