OrganizationActive
Our Homes South, Inc
NPI 1184705634 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Medford, MN
Provider details
- NPI number
- 1184705634
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Dennis Burgess, Chief Executive Officer(507) 455-2114
- License
- 8092892WS (MN)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 8065272WS (MN)
Residential Treatment Facilities
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility320900000XLicense 8092892WS (MN)
Residential Treatment Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
113 North Main Street
Medford, MN 55049-0119
Phone: (507) 455-2114
Fax: (507) 455-2178
Street-level locationGet directions
Mailing address
Po Box 119
Medford, MN 55049-0119
Registry dates
- Enumerated
- 2006-10-18
- 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.