Provider Demographics
NPI:1558878629
Name:MINNESOTA GIRLS ACADEMY
Entity Type:Organization
Organization Name:MINNESOTA GIRLS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-525-1523
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:BRICELYN
Mailing Address - State:MN
Mailing Address - Zip Code:56014-0074
Mailing Address - Country:US
Mailing Address - Phone:507-525-1523
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 74
Practice Address - Street 2:
Practice Address - City:BRICELYN
Practice Address - State:MN
Practice Address - Zip Code:56014-0074
Practice Address - Country:US
Practice Address - Phone:507-525-1523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1081456-2-CRF261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health