Provider Demographics
NPI:1639625759
Name:NORTHLAND COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:NORTHLAND COUNSELING CENTER, INC
Other - Org Name:NORTHLAND RECOVERY PINEVIEW CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-326-1274
Mailing Address - Street 1:215 2ND AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3615
Mailing Address - Country:US
Mailing Address - Phone:218-326-1274
Mailing Address - Fax:218-327-6085
Practice Address - Street 1:912 MAIN ST
Practice Address - Street 2:UNIT B
Practice Address - City:LITTLEFORK
Practice Address - State:MN
Practice Address - Zip Code:56653-9378
Practice Address - Country:US
Practice Address - Phone:218-278-4607
Practice Address - Fax:218-278-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1081102-1-CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility