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NPI Code Detail

MEDICARE: NORTHWAY ACADEMY, INC.

MEDICARE: NORTHWAY ACADEMY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD1600XDevelopmental Disabilities Clinic/Center

General Provider Information

NPI Number : 1669056172
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWAY ACADEMY, INC.
Provider Business Mailing Address
First Line : 6600 FRANCE AVE S STE 350
Second Line :
City : EDINA
State : MN
Zip : 55435-1810
Country : US
Telephone Number : 952-563-2207
Fax Number : 952-922-6885
Provider Business Practice Location Address
First Line : 9201 OLD CEDAR AVENUE SOUTH
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2401
Country : US
Telephone Number : 952-854-1800
Fax Number : 952-945-4918
Authorized Official
Title or Position : VP & SR ASST GC
Name : MARY PATRICIA RODENBERG-ROBERTS
Credential :
Telephone Number : 952-836-2234
Provider Enumeration Date : 05/11/2021
Last Update Date : 01/23/2024

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