NPIMap

Organization Active NPI

State of Minnesota

  • Psychiatric Residential Treatment Facility
  • Moose Lake, MN
National Provider Identifier
1639355902
Registry record updated Jan 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
STATE OF MINNESOTA
Practice address
1111 Highway 73
Moose Lake, MN 55767-9452
Phone
(218) 485-5300
NPI assigned
Jan 16, 2008
Last updated
Jan 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2008

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

Authorized official

Name
Bruce J Hawkinson
Title
State Program Admin Director
Phone
(507) 931-7102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X NU Primary

Addresses

Primary practice location

1111 Highway 73
Moose Lake, MN 55767-9452

Mailing address

400 Centennial Building
658 Cedar Street
Saint Paul, MN 55155-1616

National Provider Directory

National Provider Directory
Tax ID family
St Cloud State Univ HLT28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

1111 Highway 73
Moose Lake, MN 55767
Phone (218) 485-5300

658 Cedar St
Saint Paul, MN 55155
Phone (651) 228-7000

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1639355902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CENTENNIAL BUILDING",
            "address_2": "658 CEDAR STREET",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551551616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 HIGHWAY 73",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679452",
            "telephone_number": "218-485-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "HAWKINSON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "STATE PROGRAM ADMIN DIRECTOR",
        "authorized_official_telephone_number": "507-931-7102"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moose Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.