Provider Demographics
| NPI: | 1689371205 |
|---|---|
| Name: | BESTWOOD AGENCY LLC |
| Entity type: | Organization |
| Organization Name: | BESTWOOD AGENCY LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NOOR |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | YUSSUF |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 612-845-1096 |
| Mailing Address - Street 1: | 15 31ST AVE S |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAINT CLOUD |
| Mailing Address - State: | MN |
| Mailing Address - Zip Code: | 56301-3839 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1506 33RD AVE N |
| Practice Address - Street 2: | |
| Practice Address - City: | SAINT CLOUD |
| Practice Address - State: | MN |
| Practice Address - Zip Code: | 56303-1525 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 612-845-1096 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-02-14 |
| Last Update Date: | 2024-07-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 253J00000X | Agencies | Foster Care Agency | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | |
| No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances | |
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | ||
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
