Provider Demographics
NPI:1033515994
Name:BEECHWOOD, INC
Entity Type:Organization
Organization Name:BEECHWOOD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-824-0415
Mailing Address - Street 1:310 E 38TH ST STE 322
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1300
Mailing Address - Country:US
Mailing Address - Phone:612-824-0415
Mailing Address - Fax:612-825-0789
Practice Address - Street 1:310 E 38TH ST STE 322310
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1300
Practice Address - Country:US
Practice Address - Phone:612-824-0415
Practice Address - Fax:612-825-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1316942824251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health