Healthcare Provider Details

I. General information

NPI: 1124162094
Provider Name (Legal Business Name): CDC CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E 151ST ST
BURNSVILLE MN
55306-5103
US

IV. Provider business mailing address

720 E 151ST ST
BURNSVILLE MN
55306-5103
US

V. Phone/Fax

Practice location:
  • Phone: 952-892-0129
  • Fax: 952-892-7021
Mailing address:
  • Phone: 952-892-0129
  • Fax: 952-892-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1044164-1-CDT
License Number StateMN

VIII. Authorized Official

Name: MRS. DARLENE M HART
Title or Position: AR MANAGER
Credential:
Phone: 952-894-7722