NPI 1730354549

Minnesota Sex Offender Program

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: 3200 Labore Rd. Suite 104, Vadnais Heights, MN 55110-5186

Authorised official

Name: Lynn Glancey
Title: Chief Financial Officer
Phone: (651) 539-7200

Registered specialties

Psychiatric Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 323P00000X Licence 339327 (MN)

Other Psychiatric Residential Treatment Facility providers in Minnesota →

Registry record

NPI: 1730354549
Entity type: Organization
NPI issued: 23 Apr 2008
Record last updated: 7 Jan 2026

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.