Provider Demographics
NPI:1720108491
Name:LITTLE SAND GROUP HOMES
Entity Type:Organization
Organization Name:LITTLE SAND GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-566-2342
Mailing Address - Street 1:5910 LITTLE SAND LN NE
Mailing Address - Street 2:
Mailing Address - City:REMER
Mailing Address - State:MN
Mailing Address - Zip Code:56672-4423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:218-566-2341
Practice Address - Street 1:5910 LITTLE SAND LN NE
Practice Address - Street 2:
Practice Address - City:REMER
Practice Address - State:MN
Practice Address - Zip Code:56672-4423
Practice Address - Country:US
Practice Address - Phone:218-566-2342
Practice Address - Fax:218-566-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801412322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children