Provider Demographics
NPI:1609091388
Name:CHILD AND ADOLESCENT BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CHILD AND ADOLESCENT BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-431-3693
Mailing Address - Street 1:1701 TECHNOLOGY DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201
Mailing Address - Country:US
Mailing Address - Phone:320-214-3361
Mailing Address - Fax:320-231-5901
Practice Address - Street 1:1701 TECHNOLOGY DRIVE NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201
Practice Address - Country:US
Practice Address - Phone:320-214-3361
Practice Address - Fax:320-231-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334466282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren