Organization
INDEPENDENT DISABILITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA MARIE DEROSIER (PROGRAM MANAGER)
(320) 632-2674
Entity
Organization
Contact information
Practice address
1201 5TH AVE SE, LITTLE FALLS, MN 56345-3342
(320) 632-2674
Mailing address
1201 5TH AVE SE, LITTLE FALLS, MN 56345-3342
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1047172
MN
Other
Enumeration date
05/24/2007
Last updated
08/22/2020
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