NPI Code Detail JSON Logo

1457485849 NPI number — CEDAR RIDGE TREATMENT CENTER LLC

NPI Number: 1457485849
Health Care Provider/Practitioner: CEDAR RIDGE TREATMENT CENTER LLC

Information about “1457485849” NPI (CEDAR RIDGE TREATMENT CENTER LLC) exists in 1457485849 in HTML format HTML  |  1457485849 in plain Text format TXT  |  1457485849 in PDF (Portable Document Format) PDF  |  1457485849 in an XML format XML  formats.

NPI Number : 1457485849 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457485849",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CEDAR RIDGE TREATMENT CENTER LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "550 MAIN STREET",
    "SecondLineMailingAddress": "SUITE 230",
    "MailingAddressCityName": "NEW BRIGHTON",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55112",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "612-326-7600",
    "MailingAddressFaxNumber": "651-631-3231",
    "FirstLinePracticeLocationAddress": "11400 JULIANNE AVE NORTH",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STILLWATER",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55082",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-426-3300",
    "PracticeLocationAddressFaxNumber": "651-426-0419",
    "EnumerationDate": "03/15/2007",
    "LastUpdateDate": "02/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ZEIDNER",
    "AuthorizedOfficialFirstName": "LEWIS",
    "AuthorizedOfficialMiddleName": "P",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD",
    "AuthorizedOfficialTelephoneNumber": "763-245-8278",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "806273",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "324500000X",
          "TaxonomyName": "Substance Abuse Rehabilitation Facility",
          "LicenseNumber": "10338261DS",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "324500000X",
          "TaxonomyName": "Substance Abuse Rehabilitation Facility",
          "LicenseNumber": "8062731CDT",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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