Provider Demographics
NPI:1619118908
Name:ANOKA METRO REGIONAL TREATMENT CENTER
Entity Type:Organization
Organization Name:ANOKA METRO REGIONAL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOS MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RADKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-431-5002
Mailing Address - Street 1:5217 45TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2334
Mailing Address - Country:US
Mailing Address - Phone:608-698-6062
Mailing Address - Fax:
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:651-431-5174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital