Twin Cities Impact

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

TWIN CITIES IMPACT

Practice address

11208 Hanson Blvd NW Unit 215
Coon Rapids, MN 55433-3731

Phone

(651) 329-0733

NPI assigned

Jul 3, 2023

Organization subpart

No

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

Authorized official

Name

Trila Naomie Malone, OWNER

Title

President

Phone

(651) 329-0733

Specialties & licenses 1

Addresses

Other names 1

• Twin Cities IMPACT Former legal business name

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

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688342400000",
    "number": "1124705058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11208 HANSON BLVD NW UNIT 215",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333731",
            "telephone_number": "651-329-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11208 HANSON BLVD NW UNIT 215",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333731",
            "telephone_number": "651-329-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN CITIES IMPACT",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-02",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "TRILA",
        "authorized_official_middle_name": "NAOMIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-329-0733",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twin Cities IMPACT",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Developmentally Disabled Services Day Training Agency in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Developmentally Disabled Services Day Training Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.