THERAPEUTIC COMMUNITY RESIDENCE, INC. (NPI# 1508936980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508936980 |
| Entity Type | Organization |
| Organization Name | THERAPEUTIC COMMUNITY RESIDENCE, INC. |
| Practice Address |
28100 Newberry Trail Lindstrom MN 55045-9078 |
| Mailing Address |
28100 Newberry Trail P.o. Box 742 Lindstrom MN 55045-9078 |
| Practice Telephone | 6512571507 |
| Mailing Telephone | 6512571507 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DANIEL MCNALLY (ADMINISTRATOR) |
| Authorized Official Telephone | 6512571507 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 802495 | MN | Residential Treatment Facilities |
| Street Address |
28100 NEWBERRY TRAIL |
| City | LINDSTROM |
| State | MN |
| Zip Code | 55045-9078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043818354 | Eddiction Medicine Pllc | Clinic/Center | 12018 285th Street, Lindstrom, MN 55045 | 2020-10-09 |
| 1780844613 | Deboorah A Gibson | Custodial Care Facility | 28131 Newberry Trail, Lindstrom, MN 55045 | 2008-06-13 |
| 1831356773 | Lake Optometric Vision Pa | Optometrist | 12700 Lake Blvd, Lindstrom, MN 55045 | 2008-05-19 |
| 1861534315 | Vernon Bruce Lovdokken | Optometrist | 12700 Lake Boulevard, Lindstrom, MN 55045 | 2007-02-13 |
| 1922167329 | Robert Donald Waddell Jr. | Chiropractor | 12099 Lake Blvd, Lindstrom, MN 55045 | 2006-12-08 |
| 1366516767 | Kimberley M Johnson Dc | Chiropractor | 12814 Lake Boulevard, Lindstrom, MN 55045 | 2006-11-17 |
| 1225112022 | Lindstrom Family Dentistry LLC | Dentist | 30554 Park Street North, Lindstrom, MN 55045 | 2006-10-25 |
| 1508959164 | Joseph Virga | Chiropractor | 12670 Lake Blvd, Lindstrom, MN 55045 | 2006-10-02 |
| 1609975713 | Four Winds Center for Wellness Inc | Social Worker | 28141 Lakelawn Drive, Lindstrom, MN 55045 | 2006-09-22 |
| 1629079983 | Michael A Hursh | Dentist | 30554 Park St, Lindstrom, MN 55045 | 2005-08-09 |
| Find all providers in zip 55045 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205478849 | Jobs Wholeness House of Prosperity | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 123 Garner Cir, Montrose, MN 55363-8598 | 2019-10-15 |
| 1639710593 | Alicia Marie Olson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 25844 10th St W, Zimmerman, MN 55398-8796 | 2019-10-02 |
| 1841764768 | Stepping Out Incorporated | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 603 3rd St W, Hastings, MN 55033-1127 | 2019-01-14 |
| 1841652898 | Faiza Hassan | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 10917 Humboldt Ave S, Bloomington, MN 55431-4221 | 2016-03-28 |
| 1801293444 | Shelly Olson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5448 W Island Lake Rd, Duluth, MN 55803-8405 | 2014-11-25 |
| 1306190509 | Ronald Allen Synstelien | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 607 E Fir Ave, Fergus Falls, MN 56537-1503 | 2012-11-09 |
| 1023360559 | North Homes, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 324 W Superior St Ste 400, Medical Arts Building, Duluth, MN 55802-1726 | 2012-10-08 |
| 1073742383 | Lutheran Social Service of Minnesota | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 198 Penny Lane, Leroy, MN 55951 | 2009-07-08 |
| 1952549925 | Coleman Investment | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4001 Willow Rd N, Brooklyn Park, MN 55443-1239 | 2009-01-29 |
| 1942467683 | Total Living Commitment, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 203 Woodduck Cir, Delano, MN 55328-9779 | 2008-05-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.