Provider Demographics
NPI:1326633496
Name:DESNOL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:DESNOL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWATOSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEJUWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-210-8684
Mailing Address - Street 1:5901 BROOKLYN BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 BROOKLYN BLVD STE 109
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55429-2532
Practice Address - Country:US
Practice Address - Phone:763-210-8684
Practice Address - Fax:763-208-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health