MEDICARE: COMMUNITY ADDICTION RECOVERY ENTERPRISE-

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	1056062-1-CDT	MN

General Provider Information

NPI Number	:	1164737326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ADDICTION RECOVERY ENTERPRISE-

Provider Business Mailing Address
First Line	:	1800 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1901
Country	:	US
Telephone Number	:	651-431-5252
Fax Number	:	651-431-7505

Provider Business Practice Location Address
First Line	:	444 LAFAYETTE RD N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55155-3802
Country	:	US
Telephone Number	:	651-431-3676
Fax Number	:	651-431-7505

Authorized Official
Title or Position	:	REGIONAL ADMINISTRATOR
Name	:	MR. DOUG SEILER
Credential	:
Telephone Number	:	218-736-1882

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	08/12/2010

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