Healthcare Provider Details

I. General information

NPI: 1982831533
Provider Name (Legal Business Name): SPECIALIZED TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 CENTRAL AVE. NE
MINNEAPOLIS MN
55413-1512
US

IV. Provider business mailing address

1132 CENTRAL AVE. NE
MINNEAPOLIS MN
55413-1512
US

V. Phone/Fax

Practice location:
  • Phone: 612-236-1700
  • Fax: 612-236-1701
Mailing address:
  • Phone: 612-236-1700
  • Fax: 612-236-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1054055
License Number StateMN

VIII. Authorized Official

Name: GLENN A MCGREGOR
Title or Position: VICE PRESIDENT
Credential:
Phone: 612-236-1703