Provider Demographics
NPI:1871850123
Name:MERIDIAN BEHAVIORAL HEALTH-TWIN TOWN
Entity Type:Organization
Organization Name:MERIDIAN BEHAVIORAL HEALTH-TWIN TOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:612-326-7611
Mailing Address - Street 1:1706 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3614
Mailing Address - Country:US
Mailing Address - Phone:651-645-3661
Mailing Address - Fax:651-645-0959
Practice Address - Street 1:1706 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3614
Practice Address - Country:US
Practice Address - Phone:651-645-3661
Practice Address - Fax:651-645-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301859324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility