Healthcare Provider Details

I. General information

NPI: 1245184258
Provider Name (Legal Business Name): RESCARE MINNESOTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 EARLE BROWN DR STE 100
BROOKLYN CENTER MN
55430-4100
US

IV. Provider business mailing address

6120 EARLE BROWN DR STE 100
BROOKLYN CENTER MN
55430-4100
US

V. Phone/Fax

Practice location:
  • Phone: 763-537-6612
  • Fax: 763-537-7162
Mailing address:
  • Phone: 763-537-6612
  • Fax: 763-537-7162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DENISHA CONNOR
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 502-630-7421