Provider Demographics
NPI:1275731317
Name:MINNESOTA CORRECTIONAL FACILITY -TOGO
Entity Type:Organization
Organization Name:MINNESOTA CORRECTIONAL FACILITY -TOGO
Other - Org Name:THISTLEDEW
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-376-4411
Mailing Address - Street 1:62741 COUNTY ROAD 551
Mailing Address - Street 2:
Mailing Address - City:TOGO
Mailing Address - State:MN
Mailing Address - Zip Code:55723-4509
Mailing Address - Country:US
Mailing Address - Phone:218-376-4411
Mailing Address - Fax:218-376-4489
Practice Address - Street 1:62741 COUNTY ROAD 551
Practice Address - Street 2:
Practice Address - City:TOGO
Practice Address - State:MN
Practice Address - Zip Code:55723-4509
Practice Address - Country:US
Practice Address - Phone:218-376-4411
Practice Address - Fax:218-376-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1036981CRF3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children