Provider Demographics
NPI: | 1225754971 |
---|---|
Name: | NORTHWAY ACADEMY, INC. |
Entity Type: | Organization |
Organization Name: | NORTHWAY ACADEMY, INC. |
Other - Org Name: | NORTHWAY ACADEMY, INC MANKATO |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP & SR ASST GC |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | PATRICIA |
Authorized Official - Last Name: | RODENBERG-ROBERTS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 952-836-2234 |
Mailing Address - Street 1: | 6600 FRANCE AVE S STE 350 |
Mailing Address - Street 2: | |
Mailing Address - City: | EDINA |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55435-1810 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 320-774-1908 |
Mailing Address - Fax: | 320-774-2034 |
Practice Address - Street 1: | 1700 PREMIER DRIVE |
Practice Address - Street 2: | |
Practice Address - City: | MANKATO |
Practice Address - State: | MN |
Practice Address - Zip Code: | 56001-0000 |
Practice Address - Country: | US |
Practice Address - Phone: | 320-774-1908 |
Practice Address - Fax: | 320-774-2034 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-10-14 |
Last Update Date: | 2024-01-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |