1275585564 NPI number — ANOKA METRO REGIONAL TREATMENT CENTER

Table of content: (NPI 1275585564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275585564 NPI number — ANOKA METRO REGIONAL TREATMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANOKA METRO REGIONAL TREATMENT CENTER
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:
Provider Other Organization Name Type Code:
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:
1275585564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ANOKA METRO REGIONAL TREATMENT CTR
Provider Second Line Business Mailing Address:
3301 7TH AVE NO
Provider Business Mailing Address City Name:
ANOKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55303-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-712-4000
Provider Business Mailing Address Fax Number:
651-431-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANOKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55303-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-712-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARDINAL
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official Telephone Number:
651-431-3693

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  331056 , 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)

  • Identifier: 037058400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".