PARAGON RESIDENTIAL TREATMENT FOR YOUTH LLC (NPI# 1538603683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538603683 |
| Entity Type | Organization |
| Organization Name | PARAGON RESIDENTIAL TREATMENT FOR YOUTH LLC |
| Practice Address |
12915 63rd Ave N Maple Grove MN 55369-6001 |
| Practice Telephone | 9528268420 |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2016-12-08 |
| Authorized Official Name | RANDALL DRAGER (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7637626809 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | MN | Residential Treatment Facilities |
| Street Address |
12915 63RD AVE N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-6001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932410743 | Kyle R Cedermark | Psychiatry & Neurology | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2010-06-25 |
| 1710432935 | Rebekah Birmingham | Counselor | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2016-08-17 |
| 1093179020 | Tracy Kuphal-strand | Social Worker | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2016-04-06 |
| 1689071698 | Emily Gutlovics | Social Worker | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2014-11-20 |
| 1124449392 | Jody Wallin | Social Worker | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2013-12-13 |
| 1063841385 | Anna Shkolnik Johnson | Social Worker | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2013-11-06 |
| 1124367149 | Calley Lauren Roers | Social Worker | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2013-02-12 |
| 1407193766 | Shannon Andrea | Counselor | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2013-01-07 |
| 1346511847 | Emily Anne Buell | Recreation Therapist | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2012-01-16 |
| 1578832978 | Andrea Rude | Psychiatric Hospital | 12915 63rd Ave N, Maple Grove, MN 55369-6001 | 2011-12-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
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| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861046427 | Cambia Hills of East Bethel LLC | Psychiatric Residential Treatment Facility | 900 189th Ave Ne, East Bethel, MN 55011-9542 | 2019-07-31 |
| 1992268726 | North Homes Inc. | Psychiatric Residential Treatment Facility | 1920 River Rd, Grand Rapids, MN 55744-4048 | 2019-04-09 |
| 1720584337 | John E Herman Home and Treatment Facility, LLC | Psychiatric Residential Treatment Facility | 351 14th Ave Sw, Rochester, MN 55902 | 2018-04-03 |
| 1619233459 | Arrowhead House | Psychiatric Residential Treatment Facility | 2217 South St, Duluth, MN 55812-2132 | 2012-04-05 |
| 1669544987 | Kidspeace Mesabi Academy Inc | Psychiatric Residential Treatment Facility | 200 Wanless Street, Buhl, MN 55713 | 2006-11-14 |
| 1073543344 | Rhsc | Psychiatric Residential Treatment Facility | 1491 Sherburne Ave, Saint Paul, MN 55104 | 2006-07-03 |
| 1154869832 | Direct Care and Treatment - Forensic Services | Psychiatric Residential Treatment Facility | 100 Freeman Dr, Saint Peter, MN 56082-3504 | 2017-02-02 |
| 1619375235 | Linda Maxine Nielson | Psychiatric Residential Treatment Facility | 1593 Hewitt Ave, Saint Paul, MN 55104-1221 | 2014-12-13 |
| 1730354549 | Minnesota Sex Offender Program | Psychiatric Residential Treatment Facility | 1111 Highway 73, Moose Lake, MN 55767-9452 | 2008-04-23 |
| 1639355902 | State of Minnesota | Psychiatric Residential Treatment Facility | 1111 Highway 73, Moose Lake, MN 55767-9452 | 2008-01-16 |
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| City | MAPLE GROVE |
| Zip Code | 55369 |
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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.