Dale Conrad Forslin
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Braham, MN
NPI 1205340577 · NPPES record last updated Nov 25, 2017
Key facts
- NPI
- 1205340577
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- License
- 1086211 (MN)
- Practice address
- 1029 Highway 65 Ste 107
Braham, MN 55006-3360 - Phone
- (763) 516-1199
- NPI assigned
- Nov 25, 2017
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1086211 | MN | MD | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | 1086211 | MN | Yes |
Addresses
Primary practice location
1029 Highway 65 Ste 107
Braham, MN 55006-3360
Mailing address
1029 Highway 65 Ste 107
Braham, MN 55006-3360
Phone (763) 516-1199
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All providers in Braham, MN · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.