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General NPI Number Information
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NPI Number | 1821422544
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Entity Type | Organization
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Legal Business Name | CROWN IMPERIAL PRESS, LLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 1935 COUNTY ROAD B2 W SUITE #102
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City | SAINT PAUL
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State | MN
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Zip | 55113-2729
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Country | US
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Telephone | 651-785-3920
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Fax |
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Provider Business Mailing Address
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Address Line | 21211 IMPERIAL AVE N
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City | FOREST LAKE
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State | MN
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Zip | 55025-9547
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Country | US
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Telephone | 651-785-3920
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. STEVEN ROGER WIESE
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Credential | M.S., M.DIV., LP
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Telephone | 651-785-3920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LP 1426
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License Number State | MN
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