Healthcare Provider Details

I. General information

NPI: 1740938430
Provider Name (Legal Business Name): NORTHSTAR COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 10 TH ST.
CLOQUET MN
55720
US

IV. Provider business mailing address

PO BOX 189
CLOQUET MN
55720
US

V. Phone/Fax

Practice location:
  • Phone: 218-626-5175
  • Fax: 218-879-2696
Mailing address:
  • Phone: 218-626-5175
  • Fax: 218-879-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER LEA WRIGHT
Title or Position: PRESIDENT
Credential: LGSW
Phone: 218-626-5175