NPI 1639355902

State of Minnesota

Organisation Psychiatric Residential Treatment Facility Moose Lake, MN

Practice location

Address: 1111 Highway 73, Moose Lake, MN 55767-9452
Phone: (218) 485-5300
Mailing address: 400 Centennial Building 658 Cedar Street, Saint Paul, MN 55155-1616

Authorised official

Name: Bruce J Hawkinson
Title: State Program Admin Director
Phone: (507) 931-7102

Registered specialties

Psychiatric Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 323P00000X

Other Psychiatric Residential Treatment Facility providers in Minnesota →

Registry record

NPI: 1639355902
Entity type: Organization
NPI issued: 16 Jan 2008
Record last updated: 16 Jan 2008

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.