1912220229 NPI number — COMMUNITY ADDICTION RECOVERY ENTERPRISES

Table of content: (NPI 1912220229)

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:
Provider Other Organization Name Type Code:
6
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)





Copyright © 2007-2025 www.npivalidator.com