Organization
BESTWOOD AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOOR YUSSUF (OWNER)
(612) 845-1096
Entity
Organization
Contact information
Practice address
1506 33RD AVE N, SAINT CLOUD, MN 56303-1525
(612) 845-1096
Mailing address
15 31ST AVE S, SAINT CLOUD, MN 56301-3839
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
253J00000X
Foster Care Agency
—
—
261Q00000X
Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/14/2023
Last updated
07/06/2024
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