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MINNESOTA SEX OFFENDER PROGRAM

Psychiatric Residential Treatment Facility

Moose Lake, Minnesota

Provider NPI: 1730354549

Organization Information:
Organization Name:  MINNESOTA SEX OFFENDER PROGRAM
Organization is Subpart
Authorized Official:  JACK  ERSKINE  MSOP ADMINISTRATIVE OFFICER  218-4855300

Practice Location:
1111 HIGHWAY 73  MOOSE LAKE, MN 55767 US
Tel: 218-485-5300  Fax: --

Business Mailing Address:
PO BOX 64979  SAINT PAUL, MN 55164 US
Tel: 651-431-3676  Fax: 651-431-7505

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y323P00000XResidential Treatment Facilities
Psychiatric Residential Treatment Facility
MN339327

Other Provider Identifiers:

IssuerNumberStateType
679415000MN05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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