NPIMap

Organization Active NPI

Minnesota Sex Offender Program

  • Psychiatric Residential Treatment Facility
  • Moose Lake, MN
National Provider Identifier
1730354549
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
339327 Issued in MN
Legal business name
MINNESOTA SEX OFFENDER PROGRAM
Practice address
1111 Highway 73
Moose Lake, MN 55767-9452
Phone
(218) 485-5300
NPI assigned
Apr 23, 2008
Organization subpart
Yes
Parent organization
MOOSE LAKE REGIONAL STATE OPERATED SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

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

Authorized official

Name
Lynn Glancey
Title
Chief Financial Officer
Phone
(651) 539-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 339327 MN Primary

Addresses

Primary practice location

1111 Highway 73
Moose Lake, MN 55767-9452

Mailing address

3200 Labore Rd.
Suite 104
Vadnais Heights, MN 55110-5186
Phone (651) 539-7200

Other identifiers 1

IdentifierTypeStateIssuer
679415000MedicaidMN

Other names 1

  • Moose Lake Regional State Operated Services Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0975545Minnesota Sex Offender Program1111 Highway 73, Moose Lake, MN 55767Certificate of waiverJun 8, 2027

National Provider Directory

National Provider Directory
Part of
Minnesota Sex Offender Program

Locations

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1730354549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 LABORE RD.",
            "address_2": "SUITE 104",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105186",
            "telephone_number": "651-539-7200",
            "fax_number": "651-431-7505"
        },
        {
            "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": "MINNESOTA SEX OFFENDER PROGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOOSE LAKE REGIONAL STATE OPERATED SERVICES",
        "enumeration_date": "2008-04-23",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A",
        "authorized_official_last_name": "GLANCEY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "651-539-7200"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "MN",
            "license": "339327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "679415000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moose Lake Regional State Operated Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.