MEDICARE: OUTREACH SIX ACRES 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	315P00000X	Intellectual Disabilities Intermediate Care Facility	801850	MN
2	315P00000X	Intellectual Disabilities Intermediate Care Facility	801851	MN
3	315P00000X	Intellectual Disabilities Intermediate Care Facility	801852	MN
4	315P00000X	Intellectual Disabilities Intermediate Care Facility	801853	MN
5	315P00000X	Intellectual Disabilities Intermediate Care Facility	1001534	MN
6	315P00000X	Intellectual Disabilities Intermediate Care Facility	803912	MN
7	315P00000X	Intellectual Disabilities Intermediate Care Facility	801854	MN

General Provider Information

NPI Number	:	1750441713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTREACH SIX ACRES INC

Provider Business Mailing Address
First Line	:	1555 118TH LN NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55448-7579
Country	:	US
Telephone Number	:	763-754-2505
Fax Number	:	763-754-0332

Provider Business Practice Location Address
First Line	:	1555 118TH LN NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55448-7579
Country	:	US
Telephone Number	:	763-754-2505
Fax Number	:	763-754-0332

Authorized Official
Title or Position	:	CONTROLLER
Name	:	CONNIE WINBAUER
Credential	:
Telephone Number	:	763-862-5436

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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Directions to “OUTREACH SIX ACRES INC ” Practice Location

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