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General NPI Number Information
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NPI Number | 1033432703
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Entity Type | Organization
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Legal Business Name | COMMUNITY ADDICTION RECOVERY ENTERPRISE
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 1808 CIVIC CENTER DR
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City | WILLMAR
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State | MN
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Zip | 56201-9446
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Country | US
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Telephone | 320-231-6006
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Fax |
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Provider Business Mailing Address
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Address Line | 444 LAFAYETTE RD N PO BOX 64979
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City | ST. PAUL
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State | MN
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Zip | 55164-0979
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Country | US
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Telephone | 651-431-3691
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Fax |
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Authorized Official
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Title or Position | REGIONAL ADMINISTRATOR
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Name | MR. DOUG SEILER
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Credential |
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Telephone | 218-739-7224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1048391-2-CDT
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License Number State | MN
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