STATE OF MINNESOTA
NPI 1639355902
Psychiatric Residential Treatment Facility in Moose Lake, MN

Active since January 16, 2008
1111 HIGHWAY 73, MOOSE LAKE, MN 55767(218) 485-5300 Get Directions Write a Review

NPPES record last updated: January 16, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About State Of Minnesota NPPES

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

STATE OF MINNESOTA (NPI 1639355902) is a healthcare organization registered as a psychiatric residential treatment facility in Moose Lake, Minnesota and active in the NPI registry since January 2008. The organization lists Bruce J Hawkinson, State Program Admin Director, as its authorized official.

NPPES Registry Identity

NPI1639355902
Entity TypeOrganization
Primary Taxonomy323P00000X
Legal Business NameSTATE OF MINNESOTA
Location Address1111 HIGHWAY 73Moose Lake, MN 55767-9452
Mailing Address400 Centennial Building, 658 Cedar StreetSaint Paul, MN 55155-1616
Organization SubpartNo
Authorized OfficialBruce J HawkinsonState Program Admin Director · (507) 931-7102
Enumeration DateJanuary 16, 2008
NPI 1639355902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychiatric Residential Treatment FacilityResidential Treatment Facilities
Taxonomy Code323P00000X
Definition
A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary
1111 HIGHWAY 73, Moose Lake, MN 55767

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine
1111 HIGHWAY 73
MOOSE LAKE, MN 55767
Nurse Practitioner (Family)
1111 HIGHWAY 73
MOOSE LAKE, MN 55767
Counselor (Professional)
1111 HIGHWAY 73
MOOSE LAKE, MN 55767
Nurse Practitioner (Psychiatric/Mental Health)
1111 HIGHWAY 73
MOOSE LAKE, MN 55767
Psychiatric Residential Treatment Facility
1111 HIGHWAY 73
MOOSE LAKE, MN 55767
Nurse Practitioner (Family)
1111 HIGHWAY 73
MOOSE LAKE, MN 55767
Marriage & Family Therapist
1111 HIGHWAY 73
MOOSE LAKE, MN 55767

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 State Of Minnesota's NPI number?

The NPI number for State Of Minnesota is 1639355902. It was assigned to this organization in the NPPES registry on January 16, 2008.

Where is State Of Minnesota located?

State Of Minnesota is located at 1111 Highway 73, Moose Lake, MN 55767. The listed phone number is (218) 485-5300.

What is State Of Minnesota's specialty?

The primary specialty registered for this NPI is Psychiatric Residential Treatment Facility with taxonomy code 323P00000X.

When was this NPI record last updated?

The NPPES record for State Of Minnesota was last updated on January 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.