Healthcare Provider Details

I. General information

NPI: 1609091388
Provider Name (Legal Business Name): CHILD AND ADOLESCENT BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TECHNOLOGY DRIVE NE
WILLMAR MN
56201
US

IV. Provider business mailing address

1701 TECHNOLOGY DRIVE NE
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-3361
  • Fax: 320-231-5901
Mailing address:
  • Phone: 320-214-3361
  • Fax: 320-231-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number334466
License Number StateMN

VIII. Authorized Official

Name: KIM CARDINAL
Title or Position: ACCOUNTS RECEIVABLE SUPERVISOR
Credential:
Phone: 651-431-3693