Organization
NORTHWEST RESIDENCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M OLLENDICK WRIGHT LICSW (EXECUTIVE DIRECTOR)
(763) 277-1038
Entity
Organization
Contact information
Practice address
4408 69TH AVE N, BROOKLYN CENTER, MN 55429-1739
(763) 566-3650
(763) 566-4217
Mailing address
4408 69TH AVE N, BROOKLYN CENTER, MN 55429-1739
(763) 566-3650
(763) 566-4217
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/30/2007
Last updated
05/24/2013
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