| Organization Name: | GJ DESTINY ADULT FOSTER HOME, LLC |
| NPI Number: | 1609007061 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VIRGINIA ANN PUFAHL (OWNER/DIRECTOR) |
| Mailing Address: | 14295 82nd St Ne Otsego |
| State: | MN US |
| Postal Code: | 553306812 |
| Phone Number: | 3206924790 |
| Fax Number: | |
| NPI Enumeration Date: | 08/04/2009 |
| NPI Last Update Date: | 08/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 1055022 1 AFC |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |