Individual
MR. DALE CONRAD FORSLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1029 HIGHWAY 65 STE 107, BRAHAM, MN 55006-3360
(763) 516-1199
Mailing address
1029 HIGHWAY 65 STE 107, BRAHAM, MN 55006-3360
(763) 516-1199
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1086211
MN
Other
Enumeration date
11/25/2017
Last updated
11/25/2017
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