MICAH HOUSE NPI 1093190258

NPI Information

NPI: 1093190258
Provider Name: MICAH HOUSE
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization
Address:
3047 5TH AVE S
MINNEAPOLIS, MN
ZIP 55408
Phone: (651) 827-0484
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MICAH HOUSE is a substance abuse rehabilitation facility in Minneapolis, MN. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. MICAH HOUSE NPI is 1093190258. The provider is registered as an organization entity type.

The provider's business location address is:

3047 5TH AVE S
MINNEAPOLIS, MN
ZIP 55408-415
Phone: (651) 827-0484
Fax: (612) 827-0485

The provider's authorized official is Anthony Scott Holmquist-burks .
The authorized official title is Clinical Supervisor and has the following contact phone number (612) 827-0484.

The enumeration date for this NPI number is 7/29/2015 and was last updated on 7/29/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	324500000X	Substance Abuse Rehabilitation Facility		303472	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	303472	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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