MEDICARE: CELEBRATE THE SPECTRUM

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	251S00000X	Community/Behavioral Health Agency	312144	MN

General Provider Information

NPI Number	:	1215267109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELEBRATE THE SPECTRUM

Provider Business Mailing Address
First Line	:	5125 10TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-1723
Country	:	US
Telephone Number	:	612-298-8037
Fax Number	:

Provider Business Practice Location Address
First Line	:	5611 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-2429
Country	:	US
Telephone Number	:	612-298-8037
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANNE BODDY HARRINGTON
Credential	:	B.A.
Telephone Number	:	612-298-8037

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	12/28/2009

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