Healthcare Provider Details

I. General information

NPI: 1578041463
Provider Name (Legal Business Name): CONTINUUM CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WATER ST W STE 210
SAINT PAUL MN
55107-2002
US

IV. Provider business mailing address

1 WATER ST W STE 210
SAINT PAUL MN
55107-2002
US

V. Phone/Fax

Practice location:
  • Phone: 651-703-3336
  • Fax: 651-393-5161
Mailing address:
  • Phone: 651-703-3336
  • Fax: 651-393-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302461
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC BACON
Title or Position: CEO
Credential: LADC
Phone: 651-703-3336