VALLEY-LAKE BOY'S HOME, INC. (NPI# 1760666903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760666903 |
| Entity Type | Organization |
| Organization Name | VALLEY-LAKE BOY'S HOME, INC. |
| Practice Address |
3850 200th Ave Breckenridge MN 56520-0411 |
| Practice Telephone | 2186434036 |
| Practice Fax Number | 2186435226 |
| Mailing Telephone | 2186434036 |
| Mailing Fax Number | 2186435226 |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2007-12-24 |
| Authorized Official Name | MR. MARK ALLEN ENGEBRETSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2186434036 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 1036970-1-CRF | MN | Residential Treatment Facilities |
| Street Address |
3850 200TH AVE |
| City | BRECKENRIDGE |
| State | MN |
| Zip Code | 56520-0411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912220229 | Community Addiction Recovery Enterprises | Clinic/Center | 3850 200th Ave, Breckenridge, MN 56520 | 2010-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831311349 | Carrie Marie Voightman | Occupational Therapist | 1110 Hwy 75, Suite A, Breckenridge, MN 56520 | 2007-05-03 |
| 1063542371 | Jan E Ketterling | Psychologist | 2400 St Francis Drive, Hope Unit St Francis Medical Center, Breckenridge, MN 56520 | 2007-03-06 |
| 1174668081 | Timoth Y John Peterson | General Acute Care Hospital | St. Francis Healthcare Campus, 2400 St. Francis Drive, Breckenridge, MN 56520 | 2007-02-20 |
| 1699859942 | Gerald Dale Brudvik | Dentist | 430 Oak St., Breckenridge, MN 56520 | 2006-10-24 |
| 1881794642 | Pamela Jean Thompson | Social Worker | 415 1/2 Nebraska Ave., Breckenridge, MN 56520 | 2006-09-22 |
| 1588600928 | Robert C Eelkema | Emergency Medicine | 2400 St Francis Dr, Breckenridge, MN 56520 | 2006-06-22 |
| 1639162381 | St. Francis Medical Center | General Acute Care Hospital | 2400 St. Francis Drive, Breckenridge, MN 56520 | 2005-08-29 |
| 1194158899 | Randi Jo Resler | Counselor | 2400 St. Francis Drive, Breckenridge, MN 56520 | 2013-08-16 |
| 1194158006 | Jennifer L Schalekamp | Physical Therapist | 430 5th St N, Breckenridge, MN 56520 | 2013-08-14 |
| 1154521516 | Laurie Jo Ann Kessler | Counselor | 2400 St. Francis Drive, Breckenridge, MN 56520 | 2007-07-23 |
| Find all providers in zip 56520 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801254867 | Julia Keehr-oleson | Residential Treatment Facility, Emotionally Disturbed Children | 1608 W River Rd, Little Falls, MN 56345-4155 | 2016-02-05 |
| 1528226370 | Avanti Center for Girls | Residential Treatment Facility, Emotionally Disturbed Children | 10300 Flanders St Ne, Blaine, MN 55449-5710 | 2008-05-29 |
| 1043402233 | Pinnacle Programs, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 401 W Luverne St, Magnolia, MN 56158-2004 | 2007-08-13 |
| 1578765269 | Kandiyohi County Group Homes | Residential Treatment Facility, Emotionally Disturbed Children | 822 Park Ave Nw, Willmar, MN 56201-2568 | 2007-06-04 |
| 1710197207 | Network for Native Futures | Residential Treatment Facility, Emotionally Disturbed Children | 6781 160th St Nw, Cass Lake, MN 56633-3049 | 2007-05-23 |
| 1376753160 | Red Lake Department of Family and Children Services | Residential Treatment Facility, Emotionally Disturbed Children | 13586 Tribal Agency Street, Redlake, MN 56671-0427 | 2007-05-23 |
| 1508995689 | Catholic Charities of The Diocese of St. Cloud | Residential Treatment Facility, Emotionally Disturbed Children | 1726 7th Ave S, Saint Cloud, MN 56301-5711 | 2007-03-05 |
| 1316076839 | Catholic Charities of The Diocese of St. Cloud | Residential Treatment Facility, Emotionally Disturbed Children | 1010 Maryland Lane, Fergus Falls, MN 56537 | 2007-03-02 |
| 1972650893 | Gerard Treatment Programs | Residential Treatment Facility, Emotionally Disturbed Children | 1111 28th St Ne, Austin, MN 55912-6410 | 2007-01-04 |
| 1093876732 | Leo A. Hoffmann Center, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1715 Sheppard Drive, St. Peter, MN 56082-0060 | 2006-12-13 |
| Find all providers with the same taxonomy | ||||
| City | BRECKENRIDGE |
| Zip Code | 56520 |
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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.