# MSOCS-SWAN LAKE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558434399
- **Authorized official:** ROGER DENEEN (RESIDENTIAL PROG SVCS DIRECTOR)
- **Authorized official phone:** (651) 582-1857

## Contact information

- **Practice address:** 1423 SWAN LAKE RD, DULUTH, MN 55811-4606
- **Practice address phone:** (218) 722-9449
- **Mailing address:** PO BOX 64979, SAINT PAUL, MN 55164-0979

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 08/22/2020