Healthcare Provider Details

I. General information

NPI: 1679619787
Provider Name (Legal Business Name): RESIDENTIAL SERVICES OF NE MN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 RICE LAKE RD
DULUTH MN
55811-2741
US

IV. Provider business mailing address

PO BOX 3008
DULUTH MN
55803-3008
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-2696
  • Fax: 218-727-2893
Mailing address:
  • Phone: 218-727-2696
  • Fax: 218-727-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TUYET VU
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 218-727-2696