Healthcare Provider Details

I. General information

NPI: 1528145638
Provider Name (Legal Business Name): COMMUNITY DRUG & ALCOHOL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501EAST HWY 13 SUITE 108
BURNSVILLE MN
55337
US

IV. Provider business mailing address

151 W BURNSVILLE PKWY SUITE 100
BURNSVILLE MN
55337-2524
US

V. Phone/Fax

Practice location:
  • Phone: 952-564-3000
  • Fax: 952-564-3031
Mailing address:
  • Phone: 952-564-3000
  • Fax: 952-847-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN PATRICK SAMMON
Title or Position: PRESIDENT
Credential: LMFT LADC
Phone: 952-564-3000