High Island Creek Residence

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

801040 Issued in MN

Legal business name

HIGH ISLAND CREEK RESIDENCE

Practice address

708 Chestnut St
Arlington, MN 55307-9628

Phone

(507) 964-5984

NPI assigned

Feb 20, 2008

Last updated

Feb 20, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Hennies

Title

President of Board

Phone

(507) 964-2256

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063680346. Details of each certification follow.

• CCN 24G312 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 24G312

Legal name

HIGH ISLAND CREEK RESIDENCE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jul 1, 1982

Last certification

Jul 8, 2025

Beds

11

Ownership / control type

Private (non-profit)

Facility address

708 Chestnut Drive
Arlington, MN 55307

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1063680346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 CHESTNUT ST",
            "city": "ARLINGTON",
            "state": "MN",
            "postal_code": "553079628",
            "telephone_number": "507-964-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 CHESTNUT ST",
            "city": "ARLINGTON",
            "state": "MN",
            "postal_code": "553079628",
            "telephone_number": "507-964-5984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH ISLAND CREEK RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "HENNIES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT OF BOARD",
        "authorized_official_telephone_number": "507-964-2256",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MN",
            "license": "801040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual Disabilities Intermediate Care Facility in Arlington, MN
• Providers in Arlington, MN by specialty
• Intellectual Disabilities Intermediate Care Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.