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General NPI Number Information
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NPI Number | 1336790088
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Entity Type | Organization
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Legal Business Name | ADDICTION HEALTH CENTER
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 1983 SLOAN PL STE 16
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City | MAPLEWOOD
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State | MN
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Zip | 55117-2004
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Country | US
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Telephone | 651-888-2463
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Fax |
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Provider Business Mailing Address
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Address Line | 1983 SLOAN PL STE 16
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City | MAPLEWOOD
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State | MN
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Zip | 55117-2004
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Country | US
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Telephone | 651-888-2463
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KINSI MIRREH
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Credential |
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Telephone | 651-888-2463
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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 |
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License Number State |
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