Organization
EDGE HEALTH CARE AND MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EKAN EKONG NP (PMHNP-BC)
(763) 498-4448
Entity
Organization
Contact information
Practice address
157 GRASS LAKE PL APT 309, SHOREVIEW, MN 55126-2063
(763) 498-4448
Mailing address
157 GRASS LAKE PL APT 309, SHOREVIEW, MN 55126-2063
(763) 498-4448
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/14/2024
Last updated
10/21/2024
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