Healthcare Provider Details

I. General information

NPI: 1225130487
Provider Name (Legal Business Name): COMMUNITY BEHAVIORAL HEALTH HOSPITAL ANNANDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ANNANDALE BLVD.
ANNANDALE MN
55302
US

IV. Provider business mailing address

3200 LABORE RD STE 104
VADNAIS HEIGHTS MN
55110-5186
US

V. Phone/Fax

Practice location:
  • Phone: 651-259-3850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number333657
License Number StateMN

VIII. Authorized Official

Name: LYNN GLANCEY
Title or Position: CFO
Credential:
Phone: 651-539-7200