1619196524 NPI number — CENTER FOR ALCOHOL AND DRUG TREATMENT, INC.

Table of content: (NPI 1619196524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619196524 NPI number — CENTER FOR ALCOHOL AND DRUG TREATMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ALCOHOL AND DRUG TREATMENT, 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:
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:
1619196524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 W SUPERIOR ST STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55802-1892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-723-8444
Provider Business Mailing Address Fax Number:
218-529-3440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 W SUPERIOR ST STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55802-1892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-723-8444
Provider Business Practice Location Address Fax Number:
218-529-3440
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SILVERNESS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
218-529-3426

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: 788855400 . This is a "STATE OF MN, DHS, CD FUND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 795255400 . This is a "STATE OF MN, DHS, CD FUND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C48DU . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8097HO . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 122711 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 195105000 . This is a "STATE OF MN, DHS, CD FUND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 398755800 . This is a "STATE OF MN, DHS, CD FUND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 657623100 . This is a "STATE OF MN, DHS, CD FUND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7C04CE . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 048755400 . This is a "STATE OF MN, DHS, CD FUND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 588756900 . This is a "STATE OF MN, DHS, CD FUND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9068CE . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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