Healthcare Provider Details

I. General information

NPI: 1265552939
Provider Name (Legal Business Name): NORTHLAND AFC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SAGINAW RD
SAGINAW MN
55779-9410
US

IV. Provider business mailing address

101 W 2ND ST SUITE 209
DULUTH MN
55802-2086
US

V. Phone/Fax

Practice location:
  • Phone: 218-729-6511
  • Fax:
Mailing address:
  • Phone: 218-722-2585
  • Fax: 218-722-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1043111-1-AFC
License Number StateMN

VIII. Authorized Official

Name: MARK STEPHEN NASH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 218-722-2585