NORTHWEST RESIDENCE, INC. (NPI# 1629198965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629198965 |
| Entity Type | Organization |
| Organization Name | NORTHWEST RESIDENCE, INC. |
| Practice Address |
4408 69th Ave N Brooklyn Center MN 55429-1739 |
| Practice Telephone | 7635663650 |
| Practice Fax Number | 7635664217 |
| Mailing Telephone | 7635663650 |
| Mailing Fax Number | 7635664217 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2013-05-24 |
| Authorized Official Name | DIANE M OLLENDICK WRIGHT (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7632771038 |
| Authorized Official Credential | LICSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| Street Address |
4408 69TH AVE N |
| City | BROOKLYN CENTER |
| State | MN |
| Zip Code | 55429-1739 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033624952 | Matthew Louis Schaut | Counselor | 4408 69th Ave N, Brooklyn Center, MN 55429-1739 | 2017-12-14 |
| 1205262821 | Vanessa Marie Heit | Social Worker | 4408 69th Ave N, Brooklyn Center, MN 55429-1739 | 2013-09-16 |
| 1245679125 | April Marie Olson | Social Worker | 4408 69th Ave N, Brooklyn Center, MN 55429-1739 | 2013-06-24 |
| 1104262336 | Rescare Minnesota, Inc. | Community/Behavioral Health | 4408 69th Ave N, Brooklyn Center, MN 55429-1739 | 2013-05-15 |
| 1194986851 | Andrew J. Thompson | Social Worker | 4408 69th Ave N, Brooklyn Center, MN 55429-1739 | 2008-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245852979 | Comfort Home Care | Home Health | 5950 Beard Ave N, Brooklyn Center, MN 55429 | 2020-05-15 |
| 1205300969 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 West Boradway Avenue, Crystal, MN 55429 | 2019-01-16 |
| 1780156208 | Crescent Cove | Pediatrics | 4201 58th Avd N., Brooklyn Center, MN 55429 | 2018-12-21 |
| 1184106254 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 W. Broadway Ave, Crystal, MN 55429 | 2018-09-05 |
| 1952889073 | Kelly Mcgregory Pediatrics LLC | Pediatrics | 6000 Bass Lake Rd Ste 102, Crystal, MN 55429 | 2018-07-31 |
| 1023510526 | Family Trust Home Health, LLC | Home Health | 5901 Brooklyn Blvd Ste 201, Brooklyn Center, MN 55429 | 2018-03-01 |
| 1962910588 | Yer Yang | Massage Therapist | 5531 Orchard Ave N, Crystal, MN 55429 | 2018-01-17 |
| 1790203347 | Akeya Bolden | Counselor | 3212 64th Ave N, Brooklyn Center, MN 55429 | 2017-09-05 |
| 1386169316 | Sadia Pauletta Kruah | Transportation Broker | 6756 Grimes Pl North, Brooklyn Center, MN 55429 | 2017-08-10 |
| 1982134904 | Chad Geyen | Marriage & Family Therapist | 3300 County Rd. 10, Brooklyn Center, MN 55429 | 2017-06-13 |
| Find all providers in zip 55429 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265973358 | James Contois | Community Based Residential Treatment Facility, Mental Illness | 6120 Earle Brown Drive, Suite 100, Brooklyn Center, MN 55430 | 2017-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730796384 | Maisa Inc. | Community Based Residential Treatment Facility, Mental Illness | 1113 E Franklin Ave Ste 208c, Minneapolis, MN 55404-2977 | 2020-09-28 |
| 1043837560 | Journey of Hope Community Housing LLC | Community Based Residential Treatment Facility, Mental Illness | 761 Case Ave, Saint Paul, MN 55106-3705 | 2020-06-30 |
| 1366005696 | Armando Cavazos | Community Based Residential Treatment Facility, Mental Illness | 84 Wabasha St S Apt 330, Saint Paul, MN 55107-1856 | 2019-04-22 |
| 1205300969 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 West Boradway Avenue, Crystal, MN 55429 | 2019-01-16 |
| 1871064840 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 300 8th Ave Ne, Minneapolis, MN 55413-2030 | 2018-12-17 |
| 1144791112 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 5546 7th St Ne, Fridley, MN 55432-5556 | 2018-12-17 |
| 1053882027 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 7701 Able St Ne, Spring Lake Park, MN 55432-2809 | 2018-12-17 |
| 1699246678 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1140 80th Ave Ne, Spring Lake Park, MN 55432-2039 | 2018-12-17 |
| 1962973933 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 6134 Woody Ln Ne, Fridley, MN 55432-5844 | 2018-12-17 |
| 1780155754 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 500 Ironton St Ne, Fridley, MN 55432-1633 | 2018-12-17 |
| Find all providers with the same taxonomy | ||||
| City | BROOKLYN CENTER |
| Zip Code | 55429 |
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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.