State of Minnesota
NPI #1639355902 in Moose Lake, Minnesota
Provider Information
- NPI Number
- 1639355902
- Entity Type
- Organization
- Organization Name
- State of Minnesota
- Primary Specialty
- Psychiatric Residential Treatment Facility
- Enumeration Date
- Jan 16, 2008
- Last Updated
- Jan 16, 2008
Practice Location
- Address
- 1111 HIGHWAY 73
- City
- Moose Lake
- State
- Minnesota
- ZIP Code
- 55767-9452
- Phone
- (218) 485-5300
Authorized Official
- Name
- BRUCE J HAWKINSON
- Title
- STATE PROGRAM ADMIN DIRECTOR
- Phone
- (507) 931-7102
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatric Residential Treatment Facility |
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