Tricia Bastian
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Walker, MN
NPI 1295291573 · NPPES record last updated Feb 12, 2019
Key facts
- NPI
- 1295291573
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- License
- 1098115 (MN)
- Practice address
- 607 4TH St S
Walker, MN 56484-6400 - Phone
- (218) 251-1365
- NPI assigned
- Feb 12, 2019
- Sex
- Female
- 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 |
|---|---|---|---|
| 1098115 | 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 | 1098115 | MN | Yes |
Addresses
Primary practice location
607 4TH St S
Walker, MN 56484-6400
Mailing address
PO Box 910
Walker, MN 56484-0910
Phone (218) 251-1365
Other providers in Walker, MN
- William J Affeldt
- Ah Gwah Ching Center
- Ah-Gwah-Ching Center
- Steven Edward Bilben
- C3 Mental Health
- Cass County MN
- Cass County MN
- Danielle Cotter
All providers in Walker, 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 Feb 12, 2019. 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.