Provider Demographics
NPI:1821150236
Name:RESIDENTIAL SERVICES OF NE MN INC.
Entity Type:Organization
Organization Name:RESIDENTIAL SERVICES OF NE MN INC.
Other - Org Name:RSI
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TUYET
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-740-7628
Mailing Address - Street 1:2900 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2915
Mailing Address - Country:US
Mailing Address - Phone:218-727-2696
Mailing Address - Fax:218-727-2893
Practice Address - Street 1:2900 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2915
Practice Address - Country:US
Practice Address - Phone:218-727-2696
Practice Address - Fax:218-727-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821150236Medicaid