OrganizationActive
Minnesota Sex Offender Program
NPI 1730354549 · Psychiatric Residential Treatment Facility · Moose Lake, MN
Provider details
- NPI number
- 1730354549
- Entity type
- Organization
- Primary specialty
- Psychiatric Residential Treatment FacilityResidential Treatment Facilities
- Parent organization
- Moose Lake Regional State Operated Services
- Organization subpart
- Yes
- Authorized official
- Lynn Glancey, Chief Financial Officer(651) 539-7200
- License
- 339327 (MN)
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 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
1111 Highway 73
Moose Lake, MN 55767-9452
Phone: (218) 485-5300
Street-level locationGet directions
Mailing address
3200 Labore Rd.
Vadnais Heights, MN 55110-5186
Other names (DBA / former)
- Other name
- Moose Lake Regional State Operated Services
Registry dates
- Enumerated
- 2008-04-23
- Last updated
- 2026-01-07
- Certified
- 2026-01-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.