Organization
STATE OF MINNESOTA DHS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISHA J ANDERSON (SKILLS DEVELOPMENT SPECIALIST)
(952) 948-2040
Entity
Organization
Contact information
Practice address
10101 1ST AVE S, BLOOMINGTON, MN 55420-4907
(952) 948-2040
Mailing address
3200 LABORE RD, VADNAIS HEIGHTS, MN 55110-5186
(651) 539-7200
(651) 431-7505
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/22/2025
Last updated
09/22/2025
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