Provider Demographics
NPI:1023360559
Name:NORTH HOMES, INC.
Entity Type:Organization
Organization Name:NORTH HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-322-4132
Mailing Address - Street 1:1880 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4085
Mailing Address - Country:US
Mailing Address - Phone:218-327-3000
Mailing Address - Fax:218-327-1871
Practice Address - Street 1:324 W SUPERIOR ST STE 400
Practice Address - Street 2:MEDICAL ARTS BUILDING
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1726
Practice Address - Country:US
Practice Address - Phone:218-733-3000
Practice Address - Fax:218-733-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1062491-1-RH320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities