NPI 1093926099

Independent Disability Services

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Little Falls, MN

Practice location

Address: 1201 5th Ave SE, Little Falls, MN 56345-3342
Phone: (320) 632-2674

Authorised official

Name: Tanya Marie Derosier
Title: Program Manager
Phone: (320) 632-2674

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X Licence 1047172 (MN)

Other Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Minnesota →

Registry record

NPI: 1093926099
Entity type: Organization
NPI issued: 24 May 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.