Peterson Colonial Homes, Inc.
Organization Active NPI Assisted Living Facility (Mental Illness) · Brookston, MN
NPI 1104037985 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1104037985
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility (Mental Illness) 3104A0625X
- License
- 0021 (MN)
- Legal business name
- PETERSON COLONIAL HOMES, INC.
- Practice address
- 4723 Nygaard Road
Brookston, MN 55711-0350 - Phone
- (218) 878-0642
- Fax
- (218) 878-2978
- NPI assigned
- May 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Duane Melvin Schraw
- Title
- Administrator
- Phone
- (218) 878-0642
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2150784 | Peterson Colonial Homes, Inc | Certificate of waiver | Jul 2, 2028 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility (Mental Illness) | 3104A0625X | 0021 | MN | Yes |
Addresses
Primary practice location
4723 Nygaard Road
Brookston, MN 55711-0350
Mailing address
PO Box 350
Brookston, MN 55711-0350
Phone (218) 878-0642
Other providers in Brookston, MN
- Ajbb Duluth Properties
- Brooke Manor Inc
- Abby Johnsen
- Jennier Renee Johnson
- Sharon Shofner Adult Foster Care
- Andrew Timothy Shofner
- Stonehaven Assisted Living Inc.
- Transitions Plus, Inc.
All providers in Brookston, MN · Assisted Living Facility (Mental Illness) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.