Provider Demographics
NPI:1912220229
Name:COMMUNITY ADDICTION RECOVERY ENTERPRISES
Entity Type:Organization
Organization Name:COMMUNITY ADDICTION RECOVERY ENTERPRISES
Other - Org Name:COMMUNITY ADDICTION RECOVERY ENTERPRISES VALLEY LAKE BOYS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-739-7224
Mailing Address - Street 1:444 LAFAYETTE RD N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55155-3802
Mailing Address - Country:US
Mailing Address - Phone:651-431-3676
Mailing Address - Fax:651-431-7505
Practice Address - Street 1:3850 200TH AVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520
Practice Address - Country:US
Practice Address - Phone:651-431-3676
Practice Address - Fax:651-431-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1046305261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder