Provider Demographics
NPI:1275977316
Name:CENTERPOINTE BEHAVIORAL HEALTH MINNEAPOLIS LLC
Entity Type:Organization
Organization Name:CENTERPOINTE BEHAVIORAL HEALTH MINNEAPOLIS LLC
Other - Org Name:CENTERPOINTE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:IRSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-393-3954
Mailing Address - Street 1:763 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8704
Mailing Address - Country:US
Mailing Address - Phone:314-393-3954
Mailing Address - Fax:636-447-6001
Practice Address - Street 1:2550 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 314N
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1052
Practice Address - Country:US
Practice Address - Phone:888-524-9196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNOT REQUIRED261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health