MEDICARE: COMMUNITY DRUG& ALCOHOL SERVICES INC

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	261Q00000X	Clinic/Center	943127601	MN
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center	943127601	MN
3	251S00000X	Community/Behavioral Health Agency	943127601	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023423	OTHER	MN	PREFERRED ONE BHP
2	070726006	OTHER	MN	MAGELLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	67161	OTHER	MN	HEALTH PARTNERS
5	87726	OTHER	MN	UNITED HC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	98D69CO	OTHER	MN	BCBS
8	131913	OTHER	MN	UCARE
9	060113009	OTHER	MN	METROPOLITAN HEALTH P
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326212184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY DRUG& ALCOHOL SERVICES INC

Provider Business Mailing Address
First Line	:	151 W BURNSVILLE PKWY STE 100
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-2525
Country	:	US
Telephone Number	:	952-564-3000
Fax Number	:	651-925-0256

Provider Business Practice Location Address
First Line	:	2675 LONG LAKE RD STE 125
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2823
Country	:	US
Telephone Number	:	952-564-3000
Fax Number	:	651-925-0256

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRIAN P SAMMON
Credential	:	LMFT, LADC
Telephone Number	:	952-564-3000

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	09/28/2018

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