Provider Demographics
NPI:1912113499
Name:OLMSTED COUNTY
Entity Type:Organization
Organization Name:OLMSTED COUNTY
Other - Org Name:CORRECTIONS RECOVERY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-328-6465
Mailing Address - Street 1:2117 CAMPUS DR. SE
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904
Mailing Address - Country:US
Mailing Address - Phone:507-328-6473
Mailing Address - Fax:507-328-6473
Practice Address - Street 1:151 4TH ST SE
Practice Address - Street 2:OLMSTED CO. GOV. CENTER AND WRF
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-3710
Practice Address - Country:US
Practice Address - Phone:507-328-7214
Practice Address - Fax:507-287-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1004055-1CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1004055-1CDTOtherRULE 31 LICENSE