Dale Conrad Forslin
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Braham, MN. Individual provider (NPI-1).
NPI number1205340577
StatusActive
Last updated in NPPESNov 25, 2017
Details
- NPI
- 1205340577
- Entity type
- Individual (NPI-1)
- Name
- Mr. Dale Conrad Forslin
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 25, 2017
- Last updated
- Nov 25, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | 1086211 | MN | Yes |
Practice location
1029 Highway 65 Ste 107Braham, MN 55006-3360
Phone 763-516-1199
Mailing address
1029 Highway 65 Ste 107Braham, MN 55006-3360
Phone 763-516-1199
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