Organization
ANCHOR HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMOTOLA EDISON-EDEBOR (MANAGING MEMBER)
(612) 229-1012
Entity
Organization
Contact information
Practice address
6292 CENTURY BLVD, BROOKLYN PARK, MN 55429-1031
(763) 432-5488
Mailing address
5501 LAKELAND AVE N STE 101C, CRYSTAL, MN 55429-3171
(763) 843-1469
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A427110300
—
MN
05
—
A487497100
—
MN
05
—
A574462400
—
MN
Enumeration date
01/08/2022
Last updated
01/08/2022
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