Provider Demographics
NPI:1588672034
Name:WESMAR OF INTERNATIONAL FALLS MN LLC
Entity Type:Organization
Organization Name:WESMAR OF INTERNATIONAL FALLS MN LLC
Other - Org Name:RATIONAL ALTERNATIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:218-285-7029
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-0593
Mailing Address - Country:US
Mailing Address - Phone:218-285-7029
Mailing Address - Fax:218-285-7072
Practice Address - Street 1:900 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2217
Practice Address - Country:US
Practice Address - Phone:218-285-7029
Practice Address - Fax:218-285-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10371421CDT261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN126613600Medicaid