Provider Demographics
NPI:1841852639
Name:NORTHWAY ACADEMY, INC.
Entity type:Organization
Organization Name:NORTHWAY ACADEMY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & SR ASST GC
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RODENBERG-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-836-2234
Mailing Address - Street 1:6600 FRANCE AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1810
Mailing Address - Country:US
Mailing Address - Phone:952-563-2207
Mailing Address - Fax:952-922-6885
Practice Address - Street 1:205 14TH AVE E
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4500
Practice Address - Country:US
Practice Address - Phone:320-774-3915
Practice Address - Fax:320-774-3918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REM CENTRAL LAKES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health