Provider Demographics
NPI:1407976582
Name:RIVERPLACE COUNSELING CENTERS INC
Entity Type:Organization
Organization Name:RIVERPLACE COUNSELING CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BOOKWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:LIC ALCOHOL AND DRUG
Authorized Official - Phone:763-427-9777
Mailing Address - Street 1:6058 HIGHWAY 10 NW
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4530
Mailing Address - Country:US
Mailing Address - Phone:763-421-5590
Mailing Address - Fax:763-427-6876
Practice Address - Street 1:6058 HIGHWAY 10 NW
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4530
Practice Address - Country:US
Practice Address - Phone:763-421-5590
Practice Address - Fax:763-427-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8061421CDT261QR0405X
MN8083761CDT261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0949OtherREVENUE CODE
1247315OtherSTATE
MNH2035OtherPROC CODE
MNH2035OtherPROC CODE