MALISSA ANN COSTANZO OWNER NPI 1003394479

NPI Information

  • NPI: 1003394479
  • Provider Name: MALISSA ANN COSTANZO, OWNER
  • Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
  • Entity Type: Individual
  • Address: 844 8TH AVE SE
    FOREST LAKE, MN
    ZIP 55025
  • Phone: (651) 272-5608

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NPI Details

Malissa Ann Costanzo, OWNER is a community based residential treatment facility, intellectual and/or developmental disabilities in Forest Lake, MN. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. Malissa Ann Costanzo, OWNER NPI is 1003394479. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

844 8TH AVE SE
FOREST LAKE, MN
ZIP 55025
Phone: (651) 272-5608

The enumeration date for this NPI number is 7/30/2018 and was last updated on 8/1/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1253J00000XFoster Care Agency1094965-1-HCBSMINNESOTANo
2320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities1094965-1-HCBSMINNESOTAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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