OrganizationActive
Therapeutic Community Residence, Inc.
NPI 1508936980 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Lindstrom, MN
Provider details
- NPI number
- 1508936980
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Daniel Mcnally, Administrator(651) 257-1507
- License
- 802495 (MN)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense 802495 (MN)
Residential Treatment Facilities
Practice location
28100 Newberry Trail
Lindstrom, MN 55045-9078
Phone: (651) 257-1507
Approximate (ZIP-level) locationGet directions
Mailing address
28100 Newberry Trail
Lindstrom, MN 55045-9078
Registry dates
- Enumerated
- 2006-11-09
- 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.