Provider Demographics
NPI:1023362027
Name:SPECIALIZED TREATMENT SERVICES, INC. - BROOKLYN PARK
Entity Type:Organization
Organization Name:SPECIALIZED TREATMENT SERVICES, INC. - BROOKLYN PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:WILLIAM EDWARD
Authorized Official - Last Name:VEECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-902-5916
Mailing Address - Street 1:1132 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1512
Mailing Address - Country:US
Mailing Address - Phone:612-236-1700
Mailing Address - Fax:612-236-1743
Practice Address - Street 1:7472 LAKELAND BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-0000
Practice Address - Country:US
Practice Address - Phone:612-236-1700
Practice Address - Fax:612-236-1743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED TREATMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-30
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1063313261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone