Provider Demographics
NPI:1417718636
Name:ANSO RESIDENTIAL HOMES LLC
Entity Type:Organization
Organization Name:ANSO RESIDENTIAL HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHUMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-415-6655
Mailing Address - Street 1:1175 REED ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3071
Mailing Address - Country:US
Mailing Address - Phone:763-415-6655
Mailing Address - Fax:
Practice Address - Street 1:1175 REED ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3071
Practice Address - Country:US
Practice Address - Phone:763-415-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities