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General NPI Number Information
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NPI Number | 1962379933
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Entity Type | Organization
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Legal Business Name | NBH JACKSON ST LLC
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1609 JACKSON ST
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City | SAINT PAUL
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State | MN
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Zip | 55117-3917
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Country | US
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Telephone | 651-487-4987
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 ARIEL ST N
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2248
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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 | CEO
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Name | MARK WELDLER
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Credential |
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Telephone | 773-919-9351
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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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