Healthcare Provider Details

I. General information

NPI: 1902012107
Provider Name (Legal Business Name): METRO TREATMENT OF MINNESOTA, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E CENTRAL ENTRANCE SUITE B
DULUTH MN
55811-5508
US

IV. Provider business mailing address

14050 TOWN LOOP BLVD SUITE 204
ORLANDO FL
32837-6190
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-0223
  • Fax: 218-786-0226
Mailing address:
  • Phone: 407-351-7080
  • Fax: 407-351-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number261964-8
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1008733-1-CDT
License Number StateMN

VIII. Authorized Official

Name: PATRICK JOHN CHUNN
Title or Position: CFO
Credential:
Phone: 407-351-7080