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Ambulatory Health Care Facilities Clinic/Center Adolescent and Children Mental Health

Provider NPI: 1407949167

Organization Information:
Organization is not Subpart
Authorized Official:  MELISSA  HEROLD  CONTROLLER  218-623-6425

Practice Location:
Tel: 218-728-7500  Fax: 218-728-7408

Business Mailing Address:
Tel: 218-728-7500  Fax: 218-728-7501

NPI Information:
NPI: 1407949167
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N261QM0855XAmbulatory Health Care Facilities
Adolescent and Children Mental Health
Y322D00000XResidential Treatment Facilities
Residential Treatment Facility, Emotionally Disturbed Children

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 322D00000X





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