Provider Demographics
NPI:1952466195
Name:RESIDENTIAL ADVANTAGES, INC
Entity Type:Organization
Organization Name:RESIDENTIAL ADVANTAGES, INC
Other - Org Name:
Other - Org Type:
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 1:220 MILWAUKEE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKEFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56150-9495
Mailing Address - Country:US
Mailing Address - Phone:507-662-5236
Mailing Address - Fax:507-662-5235
Practice Address - Street 1:1708 N GARDEN ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1556
Practice Address - Country:US
Practice Address - Phone:507-359-7317
Practice Address - Fax:507-354-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801708-1-RS310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN940745600Medicaid