Healthcare Provider Details

I. General information

NPI: 1821150236
Provider Name (Legal Business Name): RESIDENTIAL SERVICES OF NE MN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 PIEDMONT AVE
DULUTH MN
55811-2915
US

IV. Provider business mailing address

2900 PIEDMONT AVE
DULUTH MN
55811-2915
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 TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TUYET VU
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 218-740-7628