Provider Demographics
NPI:1093225930
Name:THE ANCHOR HEALTH AND SUPPOET SERVICES
Entity Type:Organization
Organization Name:THE ANCHOR HEALTH AND SUPPOET SERVICES
Other - Org Name:THE ANCHOR HEALTH ANS SUPPORT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:WADEHYENE
Authorized Official - Last Name:APPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:245D HCBS
Authorized Official - Phone:763-205-9481
Mailing Address - Street 1:6235 UNIVERSITY AVE NE # 7
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4916
Mailing Address - Country:US
Mailing Address - Phone:763-205-9481
Mailing Address - Fax:763-205-4674
Practice Address - Street 1:6235 UNIVERSITY AVE NE # 7
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4916
Practice Address - Country:US
Practice Address - Phone:763-205-9481
Practice Address - Fax:763-205-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1083352-1-HCBS251T00000X, 253Z00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care