Provider Demographics
NPI:1467257873
Name:FORTUNATE HOMES LLC
Entity type:Organization
Organization Name:FORTUNATE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DESIGNATOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBWAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-994-5356
Mailing Address - Street 1:7006 E FISH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2832
Mailing Address - Country:US
Mailing Address - Phone:952-994-5356
Mailing Address - Fax:952-674-7774
Practice Address - Street 1:7006 E FISH LAKE RD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2832
Practice Address - Country:US
Practice Address - Phone:952-994-5356
Practice Address - Fax:952-674-7774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORTUNATE HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care