| Northwest Residence, Inc. | |
|
4408 69th Ave N Brooklyn Center MN 55429-1739 | |
| (763) 566-3650 | |
| (763) 566-4217 |
| Full Name | Northwest Residence, Inc. |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 4408 69th Ave N, Brooklyn Center, Minnesota |
| Authorized Official Name and Position | Diane M Ollendick Wright (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7632771038 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Residence, Inc. 4408 69th Ave N Brooklyn Center MN 55429-1739 Ph: (763) 566-3650 | Northwest Residence, Inc. 4408 69th Ave N Brooklyn Center MN 55429-1739 Ph: (763) 566-3650 |
| NPI Number | 1629198965 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 05/24/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629198965 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Primary |
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