NORTHWEST RESIDENCE INC. NPI 1629198965

NPI Information

NPI: 1629198965
Provider Name: NORTHWEST RESIDENCE, INC.
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization

CLIA Number: 24D0402688

Address:
4408 69TH AVE N
BROOKLYN CENTER, MN
ZIP 55429
Phone: (763) 566-3650
Get Directions

NORTHWEST RESIDENCE, INC. is a community based residential treatment facility mental illness in Brooklyn Center, MN. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. NORTHWEST RESIDENCE, INC. NPI is 1629198965. The provider is registered as an organization entity type.

The provider's business location address is:

4408 69TH AVE N
BROOKLYN CENTER, MN
ZIP 55429-739
Phone: (763) 566-3650
Fax: (763) 566-4217

The provider's authorized official is Diane M Ollendick Wright .
The authorized official title is Executive Director and has the following contact phone number (763) 277-1038.

The CLIA number assigned to this NPI record is 24D0402688 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 3/30/2007 and was last updated on 5/24/2013.

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
1	251S00000X	Community/Behavioral Health				No
2	320800000X	Community Based Residential Treatment Facility, Mental Illness				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	283666100	MEDICARE UPIN	MINNESOTA

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: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »