Provider Demographics
NPI:1033432703
Name:COMMUNITY ADDICTION RECOVERY ENTERPRISE
Entity Type:Organization
Organization Name:COMMUNITY ADDICTION RECOVERY ENTERPRISE
Other - Org Name:COMMUNITY ADDICTION RECOVERY ENTERPRISE DETENTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-739-7224
Mailing Address - Street 1:444 LAFAYETTE RD N
Mailing Address - Street 2:PO BOX 64979
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164-0979
Mailing Address - Country:US
Mailing Address - Phone:651-431-3691
Mailing Address - Fax:
Practice Address - Street 1:1808 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9446
Practice Address - Country:US
Practice Address - Phone:320-231-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1048391-2-CDT261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder