Healthcare Provider Details

I. General information

NPI: 1902712169
Provider Name (Legal Business Name): BROOKPARK HOME HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W LAFAYETTE FRONTAGE RD STE 100
SAINT PAUL MN
55107-1628
US

IV. Provider business mailing address

245 W LAFAYETTE FRONTAGE RD STE 100
SAINT PAUL MN
55107-1628
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-1661
  • Fax: 651-646-1771
Mailing address:
  • Phone: 651-646-1661
  • Fax: 651-646-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIE ANDERSON
Title or Position: MANAGER
Credential:
Phone: 320-413-0050