Provider Demographics
NPI:1093248585
Name:LAKES ADULT DAY CARE INC
Entity Type:Organization
Organization Name:LAKES ADULT DAY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHADAR
Authorized Official - Middle Name:JIGRE
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-829-6945
Mailing Address - Street 1:1516 EAST LAKE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-483-9769
Mailing Address - Fax:612-435-4934
Practice Address - Street 1:1516 EAST LAKE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-483-9769
Practice Address - Fax:612-435-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care