Northwest Residence, Inc.
NPI #1629198965 in Brooklyn Center, Minnesota
Provider Information
- NPI Number
- 1629198965
- Entity Type
- Organization
- Organization Name
- Northwest Residence, Inc.
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- Mar 30, 2007
- Last Updated
- May 24, 2013
Practice Location
- Address
- 4408 69TH AVE N
- City
- Brooklyn Center
- State
- Minnesota
- ZIP Code
- 55429-1739
- Phone
- (763) 566-3650
Authorized Official
- Name
- DIANE M OLLENDICK WRIGHT, LICSW
- Title
- EXECUTIVE DIRECTOR
- Phone
- (763) 277-1038
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
| Community Based Residential Treatment Facility, Mental Illness |
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