Valley-Lake Boy's Home, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

1036970-1-CRF Issued in MN

Legal business name

VALLEY-LAKE BOY'S HOME, INC.

Practice address

3850 200TH Ave
Breckenridge, MN 56520-0411

Phone

(218) 643-4036

Fax

(218) 643-5226

NPI assigned

Dec 24, 2007

Last updated

Dec 24, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mark Allen Engebretson

Title

Executive Director

Phone

(218) 643-4036

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198454400000",
    "number": "1760666903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 200TH AVE",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565200411",
            "telephone_number": "218-643-4036",
            "fax_number": "218-643-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 200TH AVE",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565200411",
            "telephone_number": "218-643-4036",
            "fax_number": "218-643-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY-LAKE BOY'S HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-24",
        "last_updated": "2007-12-24",
        "status": "A",
        "authorized_official_last_name": "ENGEBRETSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "218-643-4036",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MN",
            "license": "1036970-1-CRF",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Breckenridge, MN
• Providers in Breckenridge, MN by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; 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.