MALISSA ANN COSTANZO OWNER
NPI 1003394479
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Forest Lake, MN

Q: What is Malissa Costanzo's NPI number?

The NPI number for Malissa Costanzo is 1003394479. It was assigned to this individual provider in the NPPES registry on July 30, 2018.

Q: What is Malissa Costanzo's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Q: When was this NPI record last updated?

The NPPES record for Malissa Costanzo was last updated on August 1, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 30, 2018

844 8TH AVE SE, FOREST LAKE, MN 55025(651) 272-5608 Get Directions Write a Review

NPPES record last updated: August 1, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Malissa Ann Costanzo Owner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MALISSA ANN COSTANZO OWNER (NPI 1003394479) is an individual community based residential treatment facility, intellectual and/or developmental disabilities provider in Forest Lake, Minnesota, licensed in Minnesota (1094965-1-HCBS) and active in the NPI registry since July 2018.

NPPES Registry Identity

NPI1003394479

Entity TypeIndividualFemale

Primary Taxonomy320900000X

Provider Legal NameMALISSA ANN COSTANZOCredential: OWNER

Location Address844 8TH AVE SEForest Lake, MN 55025

Mailing Address844 8th Ave SeForest Lake, MN 55025-1642 · (651) 272-5608

Phone(651) 272-5608

Sole ProprietorYes

Enumeration DateJuly 30, 2018

Last NPPES UpdateAugust 1, 2018

✔ NPI 1003394479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320900000X

License✔ Licensed in MN · 1094965-1-HCBS

Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

Also ListedFoster Care AgencyTaxonomy 253J00000X · License 1094965-1-HCBS (MN)

844 8TH AVE SE, Forest Lake, MN 55025

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Malissa Costanzo's NPI number?

The NPI number for Malissa Costanzo is 1003394479. It was assigned to this individual provider in the NPPES registry on July 30, 2018.

Where is Malissa Costanzo located?

Malissa Costanzo practices at 844 8th Ave SE, Forest Lake, MN 55025. The listed phone number is (651) 272-5608.

What is Malissa Costanzo's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for Malissa Costanzo was last updated on August 1, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.