Organization
STATE OF MINNESOTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE J HAWKINSON (STATE PROGRAM ADMIN DIRECTOR)
(507) 931-7102
Entity
Organization
Contact information
Practice address
1111 HIGHWAY 73, MOOSE LAKE, MN 55767-9452
(218) 485-5300
Mailing address
400 CENTENNIAL BUILDING, 658 CEDAR STREET, SAINT PAUL, MN 55155-1616
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/16/2008
Last updated
01/16/2008
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