Organization
NYSTROM RESIDENTIAL TREATMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN EIDEN (VP OF CORPORATE SERVICES)
(651) 379-1750
Entity
Organization
Contact information
Practice address
19580 STATION ST, BIG LAKE, MN 55309-9411
(763) 309-2021
(763) 309-2022
Mailing address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
04/07/2025
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