Healthcare Provider Details

I. General information

NPI: 1407658081
Provider Name (Legal Business Name): ORCHARD HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7709 ORCHARD AVE N
BROOKLYN PARK MN
55443-3340
US

IV. Provider business mailing address

7709 ORCHARD AVE N
BROOKLYN PARK MN
55443-3340
US

V. Phone/Fax

Practice location:
  • Phone: 612-807-5021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JENGEIH TAMBA
Title or Position: OWNER AND EXECUTIVE DIRECTOR
Credential: ESQ
Phone: 612-807-5021