National Provider Identifier Database

MSOCS MOOSE LAKE
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

MSOCS-MOOSE LAKE
305 4TH ST
MOOSE LAKE, MN55767
Phone: 218-485-4634
Fax:
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for MSOCS-MOOSE LAKE

NPI Number 1205909991
Legal business name
LBN
MSOCS-MOOSE LAKE
Authorized official ROGER DENEEN - (RESIDENTIAL PROG SVCS DIRECTOR)
Entity Organization
Organization subpart Yes
Enumeration date 11/17/2006
Last updated 06/18/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • MN Medicaid: 303745200

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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