NORTHWEST RESIDENCE, INC.
NPI 1629198965
Community Based Residential Treatment Facility, Mental Illness in Brooklyn Center, MN
NPI Status: Active since March 30, 2007
Contact Information
4408 69TH AVE N
BROOKLYN CENTER, MN
ZIP 55429
Phone: (763) 566-3650
Fax: (763) 566-4217
- Organization
- Community Based Residential Treatment Fa...
- CLIA Number: 24D0402688
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-22-2025
About NORTHWEST RESIDENCE, INC.
This page provides the complete NPI Profile along with additional information for Northwest Residence, Inc., a provider established in Brooklyn Center, Minnesota operating as a Community Based Residential Treatment Facility, Mental Illness. The healthcare provider is registered in the NPI registry with number 1629198965 assigned on March 2007. The practitioner's primary taxonomy code is 320800000X. The provider is registered as an organization and their NPI record was last updated 13 years ago. The authorized official of this NPI record is Diane M Ollendick Wright Licsw (Executive Director)
- NPI
- 1629198965
- Provider Name
- NORTHWEST RESIDENCE, INC.
- Entity Type
- Organization
- Location Address
- 4408 69TH AVE N BROOKLYN CENTER, MN 55429
- Location Phone
- (763) 566-3650
- Location Fax
- (763) 566-4217
- Mailing Address
- 4408 69TH AVE N BROOKLYN CENTER, MN 55429
- Mailing Phone
- (763) 566-3650
- Mailing Fax
- (763) 566-4217
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-30-2007
- Last Update Date
- 05-24-2013
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Community Based Residential Treatment Facility, Mental Illness
- Taxonomy Code
- 320800000X
- Type
- Residential Treatment Facilities
- Taxonomy Description
- A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 251S00000X | Agencies | Community/Behavioral Health |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 283666100 | MEDICARE UPIN (02) | MN |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D0402688
- Facility Type
- Physician Office
- Certificate Effective Date
- December 23, 2023
- Certificate Expiration Date
- December 22, 2025
- Laboratory Director
- JONATHAN TALLMAN
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Northwest Residence, Inc. on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1629198965, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 75. The final step is to find the difference between that total and the next multiple of ten (80 - 75 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 75 is 80. The difference is the calculated check digit.
Other Providers at the Same Location
The following 4 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1629198965, enumerated as an "organization" on March 30, 2007.
The provider is located at 4408 69TH AVE N BROOKLYN CENTER, MN 55429 and the phone number is (763) 566-3650.
Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
