MEDICARE: ASPEN HOUSE

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1447989744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN HOUSE

Provider Business Mailing Address
First Line	:	505 HIGHWAY 169 N STE 500
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-6447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 VICTORIA RD S
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-4163
Country	:	US
Telephone Number	:	763-551-8640
Fax Number	:

Authorized Official
Title or Position	:	CORPORATE CONTROLLER
Name	:	DR. KENNETH VARBLE
Credential	:	MBA, ED.D.
Telephone Number	:	763-551-8640

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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Directions to “ASPEN HOUSE ” Practice Location

Language	Start Address	Practice Location

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