Provider Demographics
NPI:1912179433
Name:DAKOTA COUNTY RECEIVING CENTER, INC.
Entity Type:Organization
Organization Name:DAKOTA COUNTY RECEIVING CENTER, INC.
Other - Org Name:COCHRAN RECOVERY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-437-4209
Mailing Address - Street 1:1294 18TH ST E
Mailing Address - Street 2:BLDG 2
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3680
Mailing Address - Country:US
Mailing Address - Phone:651-437-4209
Mailing Address - Fax:651-438-4144
Practice Address - Street 1:1294 18TH ST E
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3680
Practice Address - Country:US
Practice Address - Phone:651-437-4209
Practice Address - Fax:651-438-4144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAKOTA COUNTY RECEIVING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2009-06-11
Deactivation Date:2008-08-01
Deactivation Code:
Reactivation Date:2009-06-11
Provider Licenses
StateLicense IDTaxonomies
MNFBL-0020697-25738320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNFBL002069725738OtherSTATE OF MN