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Mr. Dale Conrad Forslin
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Braham, Minnesota
NPI 1205340577

Dale Conrad Forslin is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Braham, MN. Dale Conrad Forslin practices in Braham, MN. The NPI Number for Dale Conrad Forslin is 1205340577 and holds a License No. 1086211 (Minnesota).

The current practice location address for Dale Conrad Forslin is 1029 Highway 65 Ste 107, Braham, MN and can be reached out via phone at 763-516-1199.

Location: 1029 Highway 65 Ste 107, Braham, MN, 55006-3360
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1205340577
Provider Name
Dale Conrad Forslin
Credential
Provider Entity Type
Individual
Gender
Male
Address
1029 Highway 65 Ste 107, Braham, MN, 55006-3360
Phone Number
763-516-1199
Fax Number
Provider Enumeration Date
11/25/2017
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1029 Highway 65 Ste 107
City
Braham
State
Minnesota
Zip
55006-3360
Phone Number
763-516-1199
Fax Number
person
Provider Business Mailing Address Details
Address
1029 Highway 65 Ste 107
City
Braham
State
Minnesota
Zip
55006-3360
Phone Number
763-516-1199
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
1086211 (Minnesota)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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