MR. DALE CONRAD FORSLIN (NPI# 1205340577) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205340577 |
| Entity Type | Individual |
| Full Name | MR. DALE CONRAD FORSLIN |
| Practice Address |
1029 Highway 65 Ste 107 Braham MN 55006-3360 |
| Practice Telephone | 7635161199 |
| Mailing Telephone | 7635161199 |
| Enumeration Date | 2017-11-25 |
| Last Update Date | 2017-11-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1086211 | MN | Residential Treatment Facilities |
| Street Address |
1029 HIGHWAY 65 STE 107 |
| City | BRAHAM |
| State | MN |
| Zip Code | 55006-3360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518192756 | David Michael Noren | Rehabilitation Practitioner | 521 Broadway Ave N, Braham, MN 55006 | 2009-05-18 |
| 1851513477 | James Allen Radziun | Dentist | 110 5th Street Nw, Braham, MN 55006 | 2007-05-03 |
| 1033259411 | Christine Tande Johnson | Psychologist | 521 Broadway Ave North, Five County Mental Health Center, Braham, MN 55006 | 2007-02-07 |
| 1235279621 | John Theophile Lindquist | Psychologist | 521 Broadway Avenue North, Five County Mental Health Center, Braham, MN 55006 | 2007-02-07 |
| 1679612782 | Jennifer Nell White | Psychologist | Five County Mental Health Center, 521 Broadway Avenue North, Braham, MN 55006 | 2007-02-05 |
| 1124519400 | Braham Family Dental | Clinic/Center | 110 5th St Nw, Braham, MN 55006 | 2018-05-23 |
| 1174777981 | Kimberly Jane Yzermans Nelson | Case Manager/Care Coordinator | 521 Broadway Avenue North, Firve County Mental Health Center - Braham Office, Braham, MN 55006 | 2008-11-06 |
| 1184877599 | Derek Thomas Magaard | Rehabilitation Practitioner | 521 Broadway Avenue North, Five County Mental Health Center - Braham Office, Braham, MN 55006 | 2008-10-29 |
| 1366694473 | Jody Lyn Dixon | Case Manager/Care Coordinator | 521 Broadway Avenue North, Five County Mental Health Center - Braham Office, Braham, MN 55006 | 2008-10-21 |
| 1629220736 | Roxanne Lynn Anderson | Case Manager/Care Coordinator | 521 Broadway Avenue North, Five County Mental Health Center - Braham Office, Braham, MN 55006 | 2008-10-21 |
| Find all providers in zip 55006 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184244527 | Kam Homecare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1500 Nicollet Ave Apt 305, Minneapolis, MN 55403-2724 | 2020-04-24 |
| 1477117885 | Kelly Rae Martin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13881 Schuelke Beach Rd Nw, Miltona, MN 56354 | 2019-05-01 |
| 1295291573 | Tricia Bastian | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 607 4th St S, Walker, MN 56484-6400 | 2019-02-12 |
| 1881163632 | Jacob Wrich | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 603 3rd St W Apt 1, Hastings, MN 55033-1127 | 2018-11-21 |
| 1003394479 | Malissa Ann Costanzo | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 844 8th Ave Se, Forest Lake, MN 55025 | 2018-07-30 |
| 1154814564 | Laurie K. Tazelaar-williams | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5253 W Bald Eagle Blvd, White Bear Lake, MN 55110-6532 | 2018-06-11 |
| 1952831026 | Noble Senior Center Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1094 University Ave W, Saint Paul, MN 55104 | 2017-06-12 |
| 1407396336 | Viko Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5651 69th Ave N, 203, Brooklyn Park, MN 55429-1579 | 2017-02-25 |
| 1972052702 | Marie-noel Hiol-hiol | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 14642 Quartz Ter Nw, Ramsey, MN 55303-4581 | 2016-09-21 |
| 1750839569 | Kubra Residential Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1711 W 143rd St Apt 120, Burnsville, MN 55306-7989 | 2016-09-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.