Edan Oak LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

EDAN OAK LLC

Doing business as

Edan Oak assisted living

Practice address

6216 Baker Rd
Eden Prairie, MN 55346-1928

Phone

(612) 644-0643

NPI assigned

May 20, 2025

Last updated

May 20, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandol KhalafNPI 1841660263

Title

Owner

Phone

(612) 644-0643

Specialties & licenses 3

Addresses

Other names 1

• Edan Oak assisted living Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sandol Khalaf

  • Driver
  • Saint Paul, MN
  • NPI 1841660263
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1760274203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 CEDAR AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554234647",
            "telephone_number": "612-644-0643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6216 BAKER RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553461928",
            "telephone_number": "612-644-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDAN OAK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "KHALAF",
        "authorized_official_first_name": "SANDOL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-644-0643"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edan Oak assisted living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility (Mental Illness) in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Assisted Living Facility (Mental Illness) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.