Healthcare Provider Details

I. General information

NPI: 1952466195
Provider Name (Legal Business Name): RESIDENTIAL ADVANTAGES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 03/05/2023
Certification Date: 03/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 N GARDEN ST
NEW ULM MN
56073-1556
US

IV. Provider business mailing address

220 MILWAUKEE ST STE 2
LAKEFIELD MN
56150-9495
US

V. Phone/Fax

Practice location:
  • Phone: 507-359-7317
  • Fax: 507-354-7274
Mailing address:
  • Phone: 507-662-5236
  • Fax: 507-662-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number801708-1-RS
License Number StateMN

VIII. Authorized Official

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