Organization
COMMUNITY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA SCHMIDT (ADMINISTRATOR)
(952) 443-2048
Entity
Organization
Contact information
Practice address
2483 109TH AVE NW, COON RAPIDS, MN 55433-3942
(952) 443-2048
Mailing address
1600 ARBORETUM BLVD., VICTORIA, MN 55386
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
800534
MN
Other
Enumeration date
12/13/2006
Last updated
08/22/2020
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