Provider Demographics
NPI:1053137729
Name:ADVOCATE HOUSE ASSISTED LIVING SERVICES LLC
Entity type:Organization
Organization Name:ADVOCATE HOUSE ASSISTED LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELOHOR
Authorized Official - Middle Name:BLESSING
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RE
Authorized Official - Phone:612-886-4909
Mailing Address - Street 1:17910 28TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1625
Mailing Address - Country:US
Mailing Address - Phone:612-886-4909
Mailing Address - Fax:
Practice Address - Street 1:17910 28TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1625
Practice Address - Country:US
Practice Address - Phone:612-886-4909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility