NPIMap

Organization Active NPI

Northway Academy, Inc.

  • Developmental Disabilities Clinic/Center
  • Mankato, MN
National Provider Identifier
1225754971
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
NORTHWAY ACADEMY, INC.
Practice address
1700 Premier Drive
Mankato, MN 56001-0000
Phone
(320) 774-1908
Fax
(320) 774-2034
NPI assigned
Oct 14, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Mary Patricia Rodenberg-Roberts
Title
VP & Sr Asst GC
Phone
(952) 836-2234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X Primary

Addresses

Primary practice location

1700 Premier Drive
Mankato, MN 56001-0000

Mailing address

6600 France Ave S Ste 350
Edina, MN 55435-1810
Phone (320) 774-1908

Other names 1

  • Northway Academy, Inc Mankato Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northway Academy Inc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

1700 Premier Dr
Mankato, MN 56001
Phone (507) 236-4612

NPI Registry JSON

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

{
    "created_epoch": "1665705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1225754971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351810",
            "telephone_number": "320-774-1908",
            "fax_number": "320-774-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 PREMIER DRIVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560010000",
            "telephone_number": "320-774-1908",
            "fax_number": "320-774-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWAY ACADEMY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-14",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "RODENBERG-ROBERTS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "VP & SR ASST GC",
        "authorized_official_telephone_number": "952-836-2234"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northway Academy, Inc Mankato",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northway Academy, Inc Mankato",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.