Provider Demographics
NPI:1982831533
Name:SPECIALIZED TREATMENT SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALIZED TREATMENT SERVICES, INC.
Other - Org Name:STS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-236-1703
Mailing Address - Street 1:1132 CENTRAL AVE. NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1512
Mailing Address - Country:US
Mailing Address - Phone:612-236-1700
Mailing Address - Fax:612-236-1701
Practice Address - Street 1:1132 CENTRAL AVE. NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1512
Practice Address - Country:US
Practice Address - Phone:612-236-1700
Practice Address - Fax:612-236-1701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED TREATMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1054055324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility