Provider Demographics
NPI:1336583582
Name:ANOKA PROFESSIONAL HH INC
Entity Type:Organization
Organization Name:ANOKA PROFESSIONAL HH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-754-4885
Mailing Address - Street 1:4211 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2921
Mailing Address - Country:US
Mailing Address - Phone:763-754-4885
Mailing Address - Fax:763-754-1023
Practice Address - Street 1:4211 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:763-754-4885
Practice Address - Fax:763-754-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN835147300038251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM243628700OtherUMPI
MNA642915100OtherUMPI
MN362062OtherCLASS A, PROFESSIONAL HOME CARE