Healthcare Provider Details

I. General information

NPI: 1639772684
Provider Name (Legal Business Name): TBI RESIDENTIAL AND COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 03/04/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 W SUPERIOR ST
DULUTH MN
55806-3524
US

IV. Provider business mailing address

6600 FRANCE AVE S
EDINA MN
55435-1805
US

V. Phone/Fax

Practice location:
  • Phone: 218-733-1331
  • Fax:
Mailing address:
  • Phone: 952-922-6776
  • Fax: 952-922-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRETT IAN COHEN
Title or Position: COO
Credential:
Phone: 800-388-5150