Provider Demographics
NPI:1922149855
Name:RAMSEY COUNTY DETOXIFICATION CENTER
Entity Type:Organization
Organization Name:RAMSEY COUNTY DETOXIFICATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT SERVICES MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DERUSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-266-4172
Mailing Address - Street 1:160 KELLOGG BLVD E
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1420
Mailing Address - Country:US
Mailing Address - Phone:651-266-4009
Mailing Address - Fax:
Practice Address - Street 1:160 KELLOGG BLVD E
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1420
Practice Address - Country:US
Practice Address - Phone:651-266-4009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility