1013904051 NPI number — NORTHERN PINES MENTAL HEALTH CENTER, INC.

Table of content: (NPI 1013904051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013904051 NPI number — NORTHERN PINES MENTAL HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN PINES MENTAL HEALTH CENTER, 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:
NORTHERN PINES MENTAL HEALTH CENTER
Provider Other Organization Name Type Code:
5
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:
1013904051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
1906 5TH AVE SE
Provider Business Mailing Address City Name:
LITTLE FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56345-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-632-6642
Provider Business Mailing Address Fax Number:
320-632-9525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 5TH AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56345-3317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-632-6647
Provider Business Practice Location Address Fax Number:
320-632-9525
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
320-632-6647

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  8017541MHC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , with the licence number: 1001061CDT , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 10102841CDT , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 83367N0 . This is a "BCBS OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 834755700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4788N0 . This is a "BCBS OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 98224 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 007444000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126039 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 195354100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6369 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com