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General NPI Number Information
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NPI Number | 1033581814
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Entity Type | Organization
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Legal Business Name | NORTHSTAR BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 924 RICE ST
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City | SAINT PAUL
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State | MN
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Zip | 55117-4987
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Country | US
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Telephone | 612-644-8835
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Fax |
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Provider Business Mailing Address
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Address Line | 924 RICE ST
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City | SAINT PAUL
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State | MN
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Zip | 55117-4987
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Country | US
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Telephone | 612-644-8835
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PATRICK KEMPER WILLIAM
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Credential | M.D.
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Telephone | 612-644-8835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1079088
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License Number State | MN
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