MINNESOTA SEX OFFENDER PROGRAM
NPI 1730354549
Psychiatric Residential Treatment Facility in Moose Lake, MN

Active since April 23, 2008CLIA 24D0975545 · Waiver
1111 HIGHWAY 73, MOOSE LAKE, MN 55767(218) 485-5300 Get Directions Write a Review

NPPES record last updated: January 7, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Minnesota Sex Offender Program NPPES

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

MINNESOTA SEX OFFENDER PROGRAM (NPI 1730354549) is a healthcare organization registered as a psychiatric residential treatment facility in Moose Lake, Minnesota and active in the NPI registry since April 2008. The organization holds a CLIA Waiver certificate valid through June 8, 2027 and lists Lynn Glancey, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1730354549
Entity TypeOrganization
Primary Taxonomy323P00000X
Legal Business NameMINNESOTA SEX OFFENDER PROGRAM
Location Address1111 HIGHWAY 73Moose Lake, MN 55767-9452
Mailing Address3200 Labore Rd., Suite 104Vadnais Heights, MN 55110-5186 · (651) 539-7200 · Fax (651) 431-7505
Organization SubpartYesParent: Moose Lake Regional State Operated Services
Authorized OfficialLynn GlanceyChief Financial Officer · (651) 539-7200
Enumeration DateApril 23, 2008
Last NPPES UpdateJanuary 7, 2026
NPPES CertifiedJanuary 7, 2026
NPI 1730354549 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychiatric Residential Treatment FacilityResidential Treatment Facilities
Taxonomy Code323P00000X
License Licensed in MN · 339327
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 Names 1

Other NameMoose Lake Regional State Operated Services

Other Identifiers 1

Medicaid679415000MN

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D0975545

Minnesota Sex Offender Program · Moose Lake, MN
Active · expires Jun 8, 2027
CLIA Number24D0975545
Laboratory TypeSupervised Living Facilit
Certificate Effective DateJune 9, 2025
Certificate Expiration DateJune 8, 2027
Laboratory DirectorScott G. Sutton
Laboratory Phone(651) 431-5891
Laboratory LocationMinnesota Sex Offender Program1111 Highway 73, Moose Lake, MN 55767
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Minnesota Sex Offender Program's NPI number?

The NPI number for Minnesota Sex Offender Program is 1730354549. It was assigned to this organization in the NPPES registry on April 23, 2008. The provider is also known as Moose Lake Regional State Operated Services.

Where is Minnesota Sex Offender Program located?

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

What is Minnesota Sex Offender Program's specialty?

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

Does Minnesota Sex Offender Program hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D0975545) is associated with this NPI, valid through June 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Minnesota Sex Offender Program was last updated on January 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months 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.