PINE RIDGE RESIDENCE INC NPI 1811192271

NPI Information

  • NPI: 1811192271
  • Provider Name: PINE RIDGE RESIDENCE INC
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Address: 503 HALLAN AVE
    BAGLEY, MN
    ZIP 56621
  • Phone: (218) 694-6716

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NPI Details

PINE RIDGE RESIDENCE INC is an intermediate care facility mentally retarded in Bagley, MN. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PINE RIDGE RESIDENCE INC NPI is 1811192271. The provider is registered as an organization entity type.

The provider's business location address is:

503 HALLAN AVE
BAGLEY, MN
ZIP 56621-029
Phone: (218) 694-6716
Fax: (218) 694-3799

The provider's authorized official is Donald L Blooflat .
The authorized official title is Administrator and has the following contact phone number (218) 694-6716.

The enumeration date for this NPI number is 6/18/2007 and was last updated on 8/22/2020.

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
1315P00000XIntermediate Care Facility, Intellectual DisabilitiesYes

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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