OrganizationActive
Peterson Family Living
NPI 1205050333 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Elk River, MN
Provider details
- NPI number
- 1205050333
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Kathie Peterson, Residential Coordinator(763) 441-8034
- License
- 1027767 1 WS (MN)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 1027767 1 WS (MN)
Residential Treatment Facilities
Practice location
12400 Ridgewood Dr Nw
Elk River, MN 55330-8221
Phone: (763) 441-8034
Fax: (763) 441-8034
Approximate (ZIP-level) locationGet directions
Mailing address
12400 Ridgewood Dr Nw
Elk River, MN 55330-8221
Registry dates
- Enumerated
- 2007-04-12
- 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.