Healthcare Provider Details

I. General information

NPI: 1790966828
Provider Name (Legal Business Name): COMMUNITY TRANSITIONAL SERVICES-EVELETH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MCKINLEY AVE
EVELETH MN
55734-1606
US

IV. Provider business mailing address

PO BOX 64979
SAINT PAUL MN
55164-0979
US

V. Phone/Fax

Practice location:
  • Phone: 218-744-7436
  • Fax:
Mailing address:
  • Phone: 651-431-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROD L KORNRUMPF
Title or Position: MENTAL HEALTH ADMIN OFFICER
Credential:
Phone: 651-431-5003