Minnesota : DHS
 
 
      
    
      
 


License Details

Basic license details.
MSOCS Ham Lake License status: Active
17635 Jefferson St Northeast
Ham Lake, MN 55304
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(763) 413-3326
Anoka County

License number: 1070629
License holder: Commissioner of Department of Human Services
License Holder Entity Identification Number(s): 4286619
License status: Active
Type of service: Home and Community Based Services - Community Residential Setting
Initial effective date: July 1, 2014
Last renewed or updated on: December 1, 2023
Next renewal due: November 30, 2025


License Information

This community residential setting license is a satellite operating under 245D-HCBS Program License Number 1070559.
Capacity: 3 persons, Age: 18 and older
Services Licensed To Provide:
Respite care services, out-of-home
Crisis respite, out-of-home
Foster Care services or supported living services

Restrictions: None


Satellite Locations
None

Additional information
Licensing authority: Anoka County Human Services

License holder lives onsite: No
Note: For additional information relating to providers who are licensed by an authority other than the Minnesota Department of Human Services, please contact the licensing authority directly. A directory of county agencies is online.

Public documents available for this license
Licensing Actions and Maltreatment Investigation Memorandums
Documents below appear for four years from the date of posting
Document type Date issued Format
None available for posting at this time. ------ ------


Human Services (DHS) licensing web page statement:

The information found on this web page is public information. Types of public information you will find on this website include:

  • Maltreatment investigation memorandum*
  • Licensing actions for license types other than family child foster care, including: conditional licenses, fines, revocations, indefinite suspensions, and temporary immediate suspensions (See the glossary of terms for an explanation of each type of licensing action.) Please note that licensing actions for family child foster care are public documents and available upon request from DHS.
  • Summary of reviews and investigations for family child care**
  • Decisions issued by DHS to appeals of violations cited on correction orders and conditional licenses
  • Final agency decisions for licensing actions
  • Correction Orders for license types other than family child care, child foster care, adult foster care, and family adult day service programs. Please note that correction orders are public documents and available upon request from DHS, the licensing county, or the licensing agency

*Maltreatment allegations involving a family child care or family child foster care program are conducted by the County in which the alleged incident occurred.

**Summary of reviews and investigations for all other provider types will be added in the future.

Determinations may be subject to appeal. Not all records related to the license are included on this web page. If you view information that you believe is not public, notify DHS Licensing Division immediately by calling (651) 431-6500.

Minnesota Department of Human Services website accessibility disclaimer: The Minnesota Department of Human Services has a policy of making the information on its websites accessible to people with disabilities. Pursuant to this commitment, DHS implements the provisions of the Americans with Disabilities Act and the Minnesota Human Rights Act. If you experience any difficulty accessing the content, call (651) 431-6500 or send an electronic mail message to DHS.LicensingDivision@state.mn.us to receive the subject matter in an alternative format. Indicate the nature of your accessibility problem, your preferred format, the license number of the facility, type and date of the document and your contact information so DHS can reach you with any questions in fulfilling your request.