Healthcare Provider Details

I. General information

NPI: 1659224616
Provider Name (Legal Business Name): LORI HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 BROOKLYN BLVD STE 103
BROOKLYN CENTER MN
55429-3090
US

IV. Provider business mailing address

5615 BROOKLYN BLVD STE 103
BROOKLYN CENTER MN
55429-3090
US

V. Phone/Fax

Practice location:
  • Phone: 651-352-1599
  • Fax:
Mailing address:
  • Phone: 651-352-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ANSU SANOE
Title or Position: CO-OWNER
Credential:
Phone: 651-352-1599