NORTHWEST RESIDENCE, INC. – Mental Illness Community Based Residential Treatment Facility, NPI 1629198965

NORTHWEST RESIDENCE, INC. is a healthcare provider. based in Brooklyn center, Minnesota. specializing in Mental Illness Community Based Residential Treatment Facility. The NPI Number for NORTHWEST RESIDENCE, INC. is 1629198965

Main info

Organization
Name
NORTHWEST RESIDENCE, INC.
NPI
1629198965
Phone
(763) 566-3650
Address
4408 69TH AVE N
Authorized Official
DIANE M OLLENDICK WRIGHT EXECUTIVE DIRECTOR LICSW
Enumeration Date
30 March 2007
Last Update Date
24 May 2013
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience48
Completeness75
Years active:19State licenses:0Digital endpointsOther names

Provider Addresses for NORTHWEST RESIDENCE, INC.

  • 4408 69TH AVE N

    BROOKLYN CENTER, MN 554291739

    Phone: (763) 566-3650

    Fax: (763) 566-4217

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55429)

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Reviews

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Frequently asked questions

What federal number belongs to NORTHWEST RESIDENCE, INC.?
The federal identifier for NORTHWEST RESIDENCE, INC. is NPI 1629198965.
Is NORTHWEST RESIDENCE, INC.'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Does NORTHWEST RESIDENCE, INC. list a primary specialty?
If you are matching referrals, note Mental Illness Community Based Residential Treatment Facility for NORTHWEST RESIDENCE, INC.. Clinical services aligned with this taxonomy classification.
What location shows for NORTHWEST RESIDENCE, INC.?
We surface Brooklyn Center, Minnesota for NORTHWEST RESIDENCE, INC. based on available NPPES addresses.
How can I contact NORTHWEST RESIDENCE, INC.?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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