Provider Demographics
NPI:1851457758
Name:NORTHWOOD CHILDREN'S SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHWOOD CHILDREN'S SERVICES, INC.
Other - Org Name:NORTHWOOD WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:DIR. OF Q.A.
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-625-2638
Mailing Address - Street 1:4000 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-1563
Mailing Address - Country:US
Mailing Address - Phone:218-628-0237
Mailing Address - Fax:218-628-1347
Practice Address - Street 1:4000 W 9TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807
Practice Address - Country:US
Practice Address - Phone:218-628-0237
Practice Address - Fax:218-628-1347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWOOD CHILDREN'S HOME SOCIETY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103T00000X, 104100000X
MN801777322D00000X
MN323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5A35NOOtherBCBS
MN8457171OtherMEDICA