Healthcare Provider Details

I. General information

NPI: 1457150211
Provider Name (Legal Business Name): MINNESOTA TEEN CHALLENGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WILLOW DR
ALEXANDRIA MN
56308-1332
US

IV. Provider business mailing address

740 E 24TH ST
MINNEAPOLIS MN
55404-3862
US

V. Phone/Fax

Practice location:
  • Phone: 612-373-3366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE BEAULIEU
Title or Position: CONTRACT MANAGER
Credential:
Phone: 612-373-3366