| Organization Name: | NORTHEAST RESIDENCE, INC. |
| NPI Number: | 1770628778 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORRINE MAE SCHMIDT (ADMINISTRATOR) |
| Mailing Address: | 410 Little Canada Rd E Little Canada |
| State: | MN US |
| Postal Code: | 551171629 |
| Phone Number: | 6517650217 |
| Fax Number: | 6517650212 |
| NPI Enumeration Date: | 02/20/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 801750 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |