Provider Demographics
NPI:1629338686
Name:NORTHWOODS DNA, INC.
Entity Type:Organization
Organization Name:NORTHWOODS DNA, INC.
Other - Org Name:BROOKSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-308-4334
Mailing Address - Street 1:44526 COUNTY 3
Mailing Address - Street 2:
Mailing Address - City:BECIDA
Mailing Address - State:MN
Mailing Address - Zip Code:56678-4437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2729 STATE 371 SW
Practice Address - Street 2:
Practice Address - City:PINE RIVER
Practice Address - State:MN
Practice Address - Zip Code:56474-4025
Practice Address - Country:US
Practice Address - Phone:218-587-3304
Practice Address - Fax:218-587-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN357493310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility