Provider Demographics
NPI: | 1790966828 |
---|---|
Name: | COMMUNITY TRANSITIONAL SERVICES-EVELETH |
Entity Type: | Organization |
Organization Name: | COMMUNITY TRANSITIONAL SERVICES-EVELETH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MENTAL HEALTH ADMIN OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ROD |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | KORNRUMPF |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 651-431-5003 |
Mailing Address - Street 1: | PO BOX 64979 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT PAUL |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55164-0979 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-431-3676 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 227 MCKINLEY AVE |
Practice Address - Street 2: | |
Practice Address - City: | EVELETH |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55734-1606 |
Practice Address - Country: | US |
Practice Address - Phone: | 218-744-7436 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | STATE OF MINNESOTA |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-11-16 |
Last Update Date: | 2007-11-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |