Provider Demographics
NPI:1518412907
Name:ABINTRA, INC
Entity Type:Organization
Organization Name:ABINTRA, INC
Other - Org Name:BLOOMINGTON MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-968-6097
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55323-0113
Mailing Address - Country:US
Mailing Address - Phone:612-968-6097
Mailing Address - Fax:612-435-9842
Practice Address - Street 1:200 W 98TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3820
Practice Address - Country:US
Practice Address - Phone:612-968-6097
Practice Address - Fax:612-435-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN143131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty