Provider Demographics
NPI:1750090924
Name:8417235
Entity type:Organization
Organization Name:8417235
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BABALOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-442-2455
Mailing Address - Street 1:5701 SHINGLE CREEK PKWY STE 245
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2336
Mailing Address - Country:US
Mailing Address - Phone:762-442-2455
Mailing Address - Fax:
Practice Address - Street 1:5701 SHINGLE CREEK PKWY STE 245
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2336
Practice Address - Country:US
Practice Address - Phone:763-442-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health