| Full Name | |
|---|---|
| Speciality | Residential Treatment Facility, Emotionally Disturbed Children |
| Location | 510 W Quince St, Duluth, Minnesota |
| Authorized Official Name and Position | Melissa Winkler (DIRECTOR OF QUALITY ASSURANCE) |
| Authorized Official Contact | 2186252638 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4000 W 9th St Duluth MN 55807-1563 Ph: (218) 724-3472 | 510 W Quince St Duluth MN 55811 Ph: (218) 625-0189 |
| NPI Number | 1295891083 |
|---|---|
| Provider Enumeration Date | 12/28/2006 |
| Last Update Date | 05/12/2021 |
| Certification Date | 05/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295891083 | NPI | - | NPPES |
| 0292NO | Other | BCBS | |
| 8457171 | Other | MEDICA |
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