1912220229 NPI number — COMMUNITY ADDICTION RECOVERY ENTERPRISES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912220229 NPI number — COMMUNITY ADDICTION RECOVERY ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ADDICTION RECOVERY ENTERPRISES
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:
COMMUNITY ADDICTION RECOVERY ENTERPRISES VALLEY LAKE BOYS HOME
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:
1912220229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 LAFAYETTE RD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55155-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-431-3676
Provider Business Mailing Address Fax Number:
651-431-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 200TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRECKENRIDGE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-431-3676
Provider Business Practice Location Address Fax Number:
651-431-7505
Provider Enumeration Date:
03/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SEILER
Authorized Official First Name:
DOUG
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL ADMINISTRATOR
Authorized Official Telephone Number:
218-739-7224

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  1046305 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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