OrganizationActive
Pine Ridge Residence Inc
NPI 1811192271 · Intellectual Disabilities Intermediate Care Facility · Bagley, MN
Provider details
- NPI number
- 1811192271
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Donald Blooflat, Administrator(218) 694-6716
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(89/100 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
503 Hallan Ave
Bagley, MN 56621-0029
Phone: (218) 694-6716
Fax: (218) 694-3799
Street-level locationGet directions
Mailing address
Po Box 29
Bagley, MN 56621-0029
Registry dates
- Enumerated
- 2007-06-18
- 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.