MALISSA COSTANZO, OWNER

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · FOREST LAKE, MN

Individual Active NPI 1003394479

Taxonomy & licensure

Specialty	Code	Primary	License	State
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	320900000X	✓	1094965-1-HCBS	MN
Foster Care Agency	253J00000X		1094965-1-HCBS	MN

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See all Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility providers in Minnesota →

Source: NPPES (public domain) and CMS Medicare Physician & Other Practitioners data. Not affiliated with CMS, NPPES, or any government agency.