Provider Demographics
NPI:1477854289
Name:REM HEARTLAND, INC.
Entity Type:Organization
Organization Name:REM HEARTLAND, INC.
Other - Org Name:REM HEARTLAND, INC. ODYSSEY
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-388-5150
Mailing Address - Street 1:6600 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1805
Mailing Address - Country:US
Mailing Address - Phone:952-922-6776
Mailing Address - Fax:952-922-6885
Practice Address - Street 1:1205 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4453
Practice Address - Country:US
Practice Address - Phone:952-922-6776
Practice Address - Fax:952-922-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN803838-2-WS3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN803838-2-WSMedicaid
MNUNKNOWNOtherCERTIFICATE OF REGISTRACTION MN DEPARTMENT OF HEALTH