Provider Demographics
NPI:1912283334
Name:NEW DIRECTIONS FOR CHANGE
Entity Type:Organization
Organization Name:NEW DIRECTIONS FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARLAND
Authorized Official - Middle Name:P
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-414-4814
Mailing Address - Street 1:6500 BROOKLYN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1755
Mailing Address - Country:US
Mailing Address - Phone:612-414-4814
Mailing Address - Fax:952-938-5014
Practice Address - Street 1:6500 BROOKLYN BLVD - LOWER LEVEL
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429
Practice Address - Country:US
Practice Address - Phone:612-414-4814
Practice Address - Fax:952-938-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)