location
search-icon
person
Malissa Ann Costanzo, OWNER
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Forest Lake, Minnesota
NPI 1003394479

Malissa Ann Costanzo is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Forest Lake, MN. Malissa Ann Costanzo practices in Forest Lake, MN and has the professional credentials of OWNER. The NPI Number for Malissa Ann Costanzo is 1003394479 and holds a License No. 1094965-1-HCBS (Minnesota).

The current practice location address for Malissa Ann Costanzo is 844 8Th Ave Se, Forest Lake, MN and can be reached out via phone at 651-272-5608.

Location: 844 8Th Ave Se, Forest Lake, MN, 55025-1642
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1003394479
Provider Name
Malissa Ann Costanzo
Credential
OWNER
Provider Entity Type
Individual
Gender
Female
Address
844 8Th Ave Se, Forest Lake, MN, 55025-1642
Phone Number
651-272-5608
Fax Number
Provider Enumeration Date
07/30/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
844 8Th Ave Se
City
Forest Lake
State
Minnesota
Zip
55025
Phone Number
651-272-5608
Fax Number
person
Provider Business Mailing Address Details
Address
844 8Th Ave Se
City
Forest Lake
State
Minnesota
Zip
55025
Phone Number
651-272-5608
Fax Number
person
Provider's Taxonomy Details 1
Type
Agencies
Classification
Foster Care Agency
Speciality
-
Taxonomy
253J00000X
License No.
1094965-1-HCBS (Minnesota)
Definition
A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes.
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
1094965-1-HCBS (Minnesota)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
semi-verified symbol
Badge

Use the following badge on your website to showcase your NPI number and verified status. In a field with over 8 million healthcare providers in the United States, it is important to establish your identity clearly. Displaying this badge signifies that your information is both accurate and up-to-date.