OrganizationActive
Independent Disability Services
NPI 1093926099 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Little Falls, MN
Provider details
- NPI number
- 1093926099
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Tanya Derosier, Program Manager(320) 632-2674
- License
- 1047172 (MN)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 1047172 (MN)
Residential Treatment Facilities
Practice location
1201 5th Ave Se
Little Falls, MN 56345-3342
Phone: (320) 632-2674
Approximate (ZIP-level) locationGet directions
Mailing address
1201 5th Ave Se
Little Falls, MN 56345-3342
Registry dates
- Enumerated
- 2007-05-24
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.