Provider Demographics
NPI:1457649907
Name:SPECIALIZED TREATMENT SERVICES
Entity Type:Organization
Organization Name:SPECIALIZED TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LADC
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:612-902-5926
Mailing Address - Street 1:1132 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1512
Mailing Address - Country:US
Mailing Address - Phone:612-902-5926
Mailing Address - Fax:
Practice Address - Street 1:1132 CENTRAL AVENUE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413
Practice Address - Country:US
Practice Address - Phone:612-902-5926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302035251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health