Organization
MIDWEST RESIDENTIAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAIZA HASSAN (CEO)
(651) 315-2649
Entity
Organization
Contact information
Practice address
10917 HUMBOLDT AVE S, BLOOMINGTON, MN 55431-4221
(651) 315-2649
Mailing address
7400 CEDAR AVE S, MINNEAPOLIS, MN 55423-4647
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
381821
MN
Other
Enumeration date
10/28/2017
Last updated
03/18/2024
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