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General NPI Number Information
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NPI Number | 1225130487
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Entity Type | Organization
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Legal Business Name | COMMUNITY BEHAVIORAL HEALTH HOSPITAL ANNANDALE
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 400 ANNANDALE BLVD.
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City | ANNANDALE
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State | MN
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Zip | 55302
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Country | US
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Telephone | 651-259-3850
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 LABORE RD STE 104
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55110-5186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | LYNN GLANCEY
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Credential |
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Telephone | 651-539-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 333657
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License Number State | MN
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