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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060113009	OTHER	MN	MAGELLAN
2	167105	OTHER	MN	BHP/UCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	82482	OTHER	MN	HEALTH PARTNERS
5	4D45CO	OTHER	MN	BCBS
6	060113009	OTHER	MN	METROPOLITAN HEALTH PLAN
7	87726	OTHER	MN	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1568543601
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	:	952-564-3031

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	:	DIRECTOR OF FINANCE
Name	:	MS. PATRICIA PATCHE
Credential	:	MA
Telephone Number	:	952-564-3000

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	09/28/2018

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