Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Malissa Ann Costanzo, OWNER

Individual provider Foster Care Agency · NPI 1003394479

Malissa Ann Costanzo, OWNER is a Foster Care Agency in Forest Lake, Minnesota. Practices as a sole proprietor. Licensed in Minnesota.

Licensed in
MN
In the registry since
2018
Specialties on file
2
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Practice location Address checks out

844 8th Ave SE
Forest Lake, MN 55025
Phone: (651) 272-5608
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) Taxonomy 320900000X · Licence 1094965-1-HCBS (MN)
Foster Care Agency Taxonomy 253J00000X · Licence 1094965-1-HCBS (MN)

Record details

NPI number1003394479
Entity typeIndividual (Type 1)
GenderFemale
Credentials OWNER
Sole proprietorYes
NPI enumeratedJuly 30, 2018
Last updated in NPPESAugust 1, 2018