Provider Demographics
NPI:1326212184
Name:COMMUNITY DRUG& ALCOHOL SERVICES INC
Entity Type:Organization
Organization Name:COMMUNITY DRUG& ALCOHOL SERVICES INC
Other - Org Name:OPTIONS FAMILY & BEHAVIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADC
Authorized Official - Phone:952-564-3000
Mailing Address - Street 1:151 W BURNSVILLE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2525
Mailing Address - Country:US
Mailing Address - Phone:952-564-3000
Mailing Address - Fax:651-925-0256
Practice Address - Street 1:2675 LONG LAKE RD STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2823
Practice Address - Country:US
Practice Address - Phone:952-564-3000
Practice Address - Fax:651-925-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN943127601251S00000X, 261Q00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1023423OtherPREFERRED ONE BHP
MN070726006OtherMAGELLAN
MN559159700Medicaid
MN67161OtherHEALTH PARTNERS
MN87726OtherUNITED HC
MN943127601Medicaid
MN98D69COOtherBCBS
MN131913OtherUCARE
MN060113009OtherMETROPOLITAN HEALTH P
MN165166800Medicaid