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General NPI Number Information
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NPI Number | 1104532993
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Entity Type | Organization
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Legal Business Name | ATHANOR HOUSING AND RESIDENTIAL SERVICES INC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 266 WINIFRED ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2330
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Country | US
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Telephone | 651-600-0701
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Fax | 651-705-7060
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Provider Business Mailing Address
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Address Line | 266 WINIFRED ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2330
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Country | US
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Telephone | 651-600-0701
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Fax | 651-705-7060
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHINEAS VANG
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Credential |
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Telephone | 651-399-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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