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General NPI Number Information
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NPI Number | 1770256612
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Entity Type | Organization
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Legal Business Name | NORTHWOOD CHILDREN'S HOME SOCIETY INC
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 1131 N 11TH AVE E
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City | DULUTH
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State | MN
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Zip | 55805-1517
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Country | US
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Telephone | 218-724-7953
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Fax |
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Provider Business Mailing Address
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Address Line | 714 W COLLEGE ST
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City | DULUTH
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State | MN
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Zip | 55811-4906
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Country | US
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Telephone | 218-724-8815
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Fax | 218-724-0251
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Authorized Official
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Title or Position | CFO
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Name | JAIMIE LYNN GOETTE
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Credential |
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Telephone | 218-728-7176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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