Msocs-Moose Lake
NPI #1205909991 in Moose Lake, Minnesota
Provider Information
- NPI Number
- 1205909991
- Entity Type
- Organization
- Organization Name
- Msocs-Moose Lake
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- EASTERN MINNESOTA STATE OPERATED COMMUNITY SERVICES
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Nov 17, 2006
- Last Updated
- Jun 18, 2008
Practice Location
- Address
- 305 4TH ST
- City
- Moose Lake
- State
- Minnesota
- ZIP Code
- 55767
- Phone
- (218) 485-4634
Authorized Official
- Name
- ROGER DENEEN
- Title
- RESIDENTIAL PROG SVCS DIRECTOR
- Phone
- (651) 582-1857
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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