Provider Demographics
NPI:1689974693
Name:REM CENTRAL LAKES, INC.
Entity Type:Organization
Organization Name:REM CENTRAL LAKES, INC.
Other - Org Name:REM CENTRAL LAKES, INC. MORRISON
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
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 1:1401 1ST ST NE
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2468
Practice Address - Country:US
Practice Address - Phone:320-259-6022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN831122-5-WS3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN349506OtherMN DEPARTMENT OF HEALTH CERTIFICATION OF REGISTRATION FOR HOUSING WITH SERVICES
MN349507OtherMN DEPARTMENT OF HEALTH CERTIFICATE OF REGISTRATION FOR HOUSING WITH SERVICES
MN349140OtherHOUSING WITH SERVICES CERTIFICATE OF REGISTRATION FROM THE MN DEPT OF HEALTH