Individual Healthcare Provider
Malissa Ann Costanzo, OWNER
Provider's NPPES record last updated: August 1, 2018
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1003394479
- Primary Specialty
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Practice Location
- Forest Lake, Minnesota
- Sole Proprietor
- Yes
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 18, 2026, 2:18 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Residential Treatment Facilities
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
Taxonomy code 320900000X Foster Care Agency
Agencies
A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes.
Taxonomy code 253J00000X
Provider-Reported License Information
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Minnesota)
- 1094965-1-HCBS
- Foster Care Agency (Minnesota)
- 1094965-1-HCBS
Practice Locations
Practice Location
844 8th Ave Se
Forest Lake, Minnesota 55025
Phone: (651) 272-5608
Record Information
- Enumeration Date
- July 30, 2018
- Provider's NPPES Record Last Updated
- August 1, 2018
- NPISignal NPPES Dataset
- August 2026
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