MEDICARE: REM HENNEPIN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	804409-2-WS	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306912282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REM HENNEPIN, INC.

Provider Business Mailing Address
First Line	:	6600 FRANCE AVE S
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-1805
Country	:	US
Telephone Number	:	952-922-6776
Fax Number	:	952-922-6885

Provider Business Practice Location Address
First Line	:	6200 SHINGLE CREEK PKWY STE 580
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-2170
Country	:	US
Telephone Number	:	763-852-5325
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BRETT IAN COHEN
Credential	:
Telephone Number	:	800-388-5150

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	03/04/2023

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Directions to “REM HENNEPIN, INC. ” Practice Location

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