| Intensive Outpatient Chemical Dependency Program Rule 31 | |
|
1900 Silver Lake Rd Nw Suite 110 New Brighton MN 55112-1786 | |
| (651) 628-9566 | |
| Not Available |
| Full Name | Intensive Outpatient Chemical Dependency Program Rule 31 |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1900 Silver Lake Rd Nw, New Brighton, Minnesota |
| Authorized Official Name and Position | Brian Nystrom (PRESIDENT) |
| Authorized Official Contact | 6513791734 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intensive Outpatient Chemical Dependency Program Rule 31 1900 Silver Lake Rd Nw Suite 110 New Brighton MN 55112-1786 Ph: () - | Intensive Outpatient Chemical Dependency Program Rule 31 1900 Silver Lake Rd Nw Suite 110 New Brighton MN 55112-1786 Ph: (651) 628-9566 |
| NPI Number | 1902934565 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902934565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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