Provider Demographics
NPI:1235179730
Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-WADENA
Entity Type:Organization
Organization Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-WADENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-478-8002
Mailing Address - Street 1:PO BOX 64979
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164-0979
Mailing Address - Country:US
Mailing Address - Phone:651-431-3676
Mailing Address - Fax:651-431-7505
Practice Address - Street 1:201 SHADY LANE DR
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-3093
Practice Address - Country:US
Practice Address - Phone:218-319-6001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN34861700Medicaid