MEDICARE: WILD RIVER SERVICES

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	324500000X	Substance Abuse Rehabilitation Facility
2	324500000X	Substance Abuse Rehabilitation Facility	1084357	MN

General Provider Information

NPI Number	:	1679988109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD RIVER SERVICES

Provider Business Mailing Address
First Line	:	1246 UNIVERSITY AVE W
Second Line	:	SUITE 101
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4125
Country	:	US
Telephone Number	:	651-558-9522
Fax Number	:

Provider Business Practice Location Address
First Line	:	796 CAPITOL HTS
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55103-1852
Country	:	US
Telephone Number	:	651-558-9522
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	COLIN KELLY FAULKNER II
Credential	:
Telephone Number	:	651-558-9522

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	01/20/2017

Similar Medicare Providers

1881009306 — COLIN KELLY FAULKNER II
Practice Location Address:

796 CAPITOL HTS
SAINT PAUL, MN
55103-1852

Practice Phone: 651-558-9522
Practice Fax:

1124820865 — RELIABLE RECUPERATIVE CARE LLC
Practice Location Address:

796 CAPITOL HTS
SAINT PAUL, MN
55103-1852

Practice Phone: 763-264-7641
Practice Fax:

1376604108 — MR. ALBERT GRAHAM WILSON IV LPC
Practice Location Address:

370 SELBY AVE , #316 UNION THERAPY
SAINT PAUL, MN
55102-1852

Practice Phone: 612-305-8081
Practice Fax:

1861742918 — STILLWATER MEDICAL GROUP
Practice Location Address:

700 WILDWOOD RD
SAINT PAUL, MN
55115-1852

Practice Phone: 651-439-1234
Practice Fax: 651-275-3325

1184148975 — ELLEN VUE
Practice Location Address:

1852 ORANGE AVE E
SAINT PAUL, MN
55119-4523

Practice Phone: 612-644-1507
Practice Fax:

1417438870 — OCCUPATIONAL HEALTH CENTERS OF MINNESOTA PC
Practice Location Address:

570 ASBURY ST STE 101
SAINT PAUL, MN
55104-1852

Practice Phone: 651-888-6540
Practice Fax: 651-888-6545

Directions to “WILD RIVER SERVICES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.