Provider Demographics
NPI:1619233459
Name:ARROWHEAD HOUSE
Entity Type:Organization
Organization Name:ARROWHEAD HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BREILAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-728-9195
Mailing Address - Street 1:2217 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-2132
Mailing Address - Country:US
Mailing Address - Phone:218-728-8978
Mailing Address - Fax:218-728-9382
Practice Address - Street 1:2217 SOUTH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-2132
Practice Address - Country:US
Practice Address - Phone:218-728-8978
Practice Address - Fax:218-728-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800121323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility