| Optiovillage, Inc | |
|
630 E Main St Anoka MN 55303-2527 | |
| (763) 712-1903 | |
| (763) 712-1917 |
| Full Name | Optiovillage, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 630 E Main St, Anoka, Minnesota |
| Authorized Official Name and Position | Trenton Jon Peterson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7637121903 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Optiovillage, Inc 630 East Main St. Anoka MN 55303 Ph: (763) 712-1903 | Optiovillage, Inc 630 E Main St Anoka MN 55303-2527 Ph: (763) 712-1903 |
| NPI Number | 1184002784 |
|---|---|
| Provider Enumeration Date | 05/14/2015 |
| Last Update Date | 05/14/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184002784 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Minnesota) | Primary |
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