# VALLEY-LAKE BOY'S HOME, INC.

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

## Provider details

- **NPI number:** 1760666903
- **Authorized official:** MR. MARK ALLEN ENGEBRETSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (218) 643-4036

## Contact information

- **Practice address:** 3850 200TH AVE, BRECKENRIDGE, MN 56520-0411
- **Practice address phone:** (218) 643-4036
- **Practice address fax:** (218) 643-5226
- **Mailing address:** 3850 200TH AVE, BRECKENRIDGE, MN 56520-0411
- **Mailing address phone:** (218) 643-4036
- **Mailing address fax:** (218) 643-5226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 1036970-1-CRF | MN | Yes |

## Other

- **Enumeration date:** 12/24/2007
- **Last updated:** 12/24/2007