Provider Demographics
NPI:1356854715
Name:ANEW
Entity Type:Organization
Organization Name:ANEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GANGL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-843-8909
Mailing Address - Street 1:453 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6001
Mailing Address - Country:US
Mailing Address - Phone:763-843-8909
Mailing Address - Fax:
Practice Address - Street 1:453 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6001
Practice Address - Country:US
Practice Address - Phone:763-843-8909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPENCE SPECIALTIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1083233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty