Provider Demographics
NPI:1588735328
Name:KESSEL GROUP HOME INC
Entity type:Organization
Organization Name:KESSEL GROUP HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KESSEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:218-736-2641
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56538-0743
Mailing Address - Country:US
Mailing Address - Phone:218-736-6612
Mailing Address - Fax:
Practice Address - Street 1:24641 WEST RIVERS BEND ROAD
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537
Practice Address - Country:US
Practice Address - Phone:218-736-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801936320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities