Provider Demographics
NPI:1194818682
Name:BRISTOL PLACE CORPORATION
Entity Type:Organization
Organization Name:BRISTOL PLACE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-871-0805
Mailing Address - Street 1:412 RIDGEWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3585
Mailing Address - Country:US
Mailing Address - Phone:612-871-0805
Mailing Address - Fax:612-871-0455
Practice Address - Street 1:412 RIDGEWOOD AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3585
Practice Address - Country:US
Practice Address - Phone:612-871-0805
Practice Address - Fax:612-871-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN803962WS320600000X
MN8025061RS320600000X
MN8014812RS320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities