NPIMap

Organization Active NPI

Rustic Ridge Specialized Residential

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Grand Blanc, MI
National Provider Identifier
1972471159
Registry record updated Oct 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
RUSTIC RIDGE SPECIALIZED RESIDENTIAL
Practice address
6624 Rustic Ridge TRL
Grand Blanc, MI 48439-4955
Phone
(833) 478-9464
NPI assigned
Oct 28, 2025
Last updated
Oct 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2025

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

Authorized official

Name
Breanna Moslander
Title
HR Admin
Phone
(833) 478-9464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

6624 Rustic Ridge TRL
Grand Blanc, MI 48439-4955

Mailing address

3060 S Dye Rd
Flint, MI 48507-1078
Phone (833) 478-9464

National Provider Directory

National Provider Directory

Locations

3060 S Dye Rd
Flint, MI 48507

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1761609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761609600000",
    "number": "1972471159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 S DYE RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071078",
            "telephone_number": "833-478-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6624 RUSTIC RIDGE TRL",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484394955",
            "telephone_number": "833-478-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSTIC RIDGE SPECIALIZED RESIDENTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-28",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A",
        "authorized_official_last_name": "MOSLANDER",
        "authorized_official_first_name": "BREANNA",
        "authorized_official_title_or_position": "HR ADMIN",
        "authorized_official_telephone_number": "833-478-9464"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2025; 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.