Healthcare Provider Details

I. General information

NPI: 1801501093
Provider Name (Legal Business Name): AZALEA HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5857 PERRY AVE N
CRYSTAL MN
55429
US

IV. Provider business mailing address

9625 SHERIDAN AVE N
BROOKLYN PARK MN
55444
US

V. Phone/Fax

Practice location:
  • Phone: 612-702-0756
  • Fax:
Mailing address:
  • Phone: 763-273-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SIAMAH KANNEH
Title or Position: CO-OWNER
Credential:
Phone: 763-273-0767