Organization
MSOCS-PINE CITY
Active
Parent organization
EASTERN MINNESOTA STATE OPERATED COMMUNITY SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTERN MINNESOTA STATE OPERATED COMMUNITY SERVICES
Authorized official
ROGER DENEEN (RESIDENTIAL PROG SVCS DIRECTOR)
(651) 582-1857
Entity
Organization
Contact information
Practice address
215 6TH AVE SE, PINE CITY, MN 55063-1915
(320) 629-2116
Mailing address
PO BOX 64979, SAINT PAUL, MN 55164-0979
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
823745000
—
MN
Enumeration date
11/17/2006
Last updated
06/18/2008
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