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Search › Minnesota › Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Malissa Costanzo, OWNER

NPI 1003394479 · on the registry since 2018 · sole proprietor

Practice

Address
844 8th Ave Se
Forest Lake, MN 55025
Phone
(651) 272-5608

Registry record

Primary taxonomy
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
320900000X
Also registered as
Foster Care Agency
Licence states on file
MN
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2018-08-01

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Minnesota