Provider Demographics
NPI:1275585564
Name:ANOKA METRO REGIONAL TREATMENT CENTER
Entity Type:Organization
Organization Name:ANOKA METRO REGIONAL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-431-3693
Mailing Address - Street 1:ANOKA METRO REGIONAL TREATMENT CTR
Mailing Address - Street 2:3301 7TH AVE NO
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1119
Mailing Address - Country:US
Mailing Address - Phone:763-712-4000
Mailing Address - Fax:651-431-7505
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:763-712-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331056283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN037058400Medicaid
MN037058400Medicaid