Provider Demographics
NPI:1417154220
Name:ANOKA COUNTY JUVENILE CENTER
Entity Type:Organization
Organization Name:ANOKA COUNTY JUVENILE CENTER
Other - Org Name:ANOKA COUNTY NON-SECURE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MELINDA
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-783-7502
Mailing Address - Street 1:7555 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1068
Mailing Address - Country:US
Mailing Address - Phone:651-783-7502
Mailing Address - Fax:651-783-8160
Practice Address - Street 1:7555 4TH AVE
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1068
Practice Address - Country:US
Practice Address - Phone:651-783-7502
Practice Address - Fax:651-783-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1036841-1-CRF101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty