Provider Demographics
NPI:1770628778
Name:NORTHEAST RESIDENCE, INC.
Entity type:Organization
Organization Name:NORTHEAST RESIDENCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORRINE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-765-0217
Mailing Address - Street 1:410 LITTLE CANADA RD E
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1629
Mailing Address - Country:US
Mailing Address - Phone:651-765-0217
Mailing Address - Fax:651-765-0212
Practice Address - Street 1:410 LITTLE CANADA RD E
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1629
Practice Address - Country:US
Practice Address - Phone:651-765-0217
Practice Address - Fax:651-765-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801750385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care