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General NPI Number Information
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NPI Number | 1053137729
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Entity Type | Organization
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Legal Business Name | ADVOCATE HOUSE ASSISTED LIVING SERVICES LLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 17910 28TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55447-1625
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Country | US
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Telephone | 612-886-4909
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Fax |
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Provider Business Mailing Address
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Address Line | 17910 28TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55447-1625
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Country | US
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Telephone | 612-886-4909
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ELOHOR BLESSING GORDON
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Credential | RE
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Telephone | 612-886-4909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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