1528145638 NPI number — COMMUNITY DRUG & ALCOHOL SERVICES INC

Table of content: (NPI 1528145638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528145638 NPI number — COMMUNITY DRUG & ALCOHOL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY DRUG & ALCOHOL SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OPTIONS FAMILY & BEHAVIOR SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528145638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 W BURNSVILLE PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BURNSVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55337-2524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-564-3000
Provider Business Mailing Address Fax Number:
952-847-4966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501EAST HWY 13
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-564-3000
Provider Business Practice Location Address Fax Number:
952-564-3031
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMMON
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-564-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87726 . This is a "UNITED HC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 167105 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 167105 . This is a "BHP/UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 943127600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007386 . This is a "DHS LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 060113009 . This is a "METROPOLITAN HP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4D45CO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 82482 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 12637 . This is a "DAKOTA COUNTY RULE 25 CONTRACT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 060113009 . This is a "MAGELLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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