Provider Demographics
NPI:1437488533
Name:FIRST STEP
Entity Type:Organization
Organization Name:FIRST STEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-947-3543
Mailing Address - Street 1:222 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:BACKUS
Mailing Address - State:MN
Mailing Address - Zip Code:56435-2209
Mailing Address - Country:US
Mailing Address - Phone:218-947-3543
Mailing Address - Fax:218-947-3549
Practice Address - Street 1:222 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:BACKUS
Practice Address - State:MN
Practice Address - Zip Code:56435-2209
Practice Address - Country:US
Practice Address - Phone:218-947-3543
Practice Address - Fax:218-947-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10557203245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children