Organization
PETERSON FAMILY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHIE R PETERSON (RESIDENTIAL COORDINATOR)
(763) 441-8034
Entity
Organization
Contact information
Practice address
12400 RIDGEWOOD DR NW, ELK RIVER, MN 55330-8221
(763) 441-8034
(763) 441-8034
Mailing address
12400 RIDGEWOOD DR NW, ELK RIVER, MN 55330-8221
(763) 441-8034
(763) 441-8034
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1027767 1 WS
MN
Other
Enumeration date
04/12/2007
Last updated
08/22/2020
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