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THE SALVATION ARMY HARBOR LIGHT CENTER BEACON PROGRAM NPI 1487785234


NPI Information

NPI: 1487785234
Provider Name: THE SALVATION ARMY HARBOR LIGHT CENTER BEACON PROGRAM

Doing Business As: SALVATION ARMY BEACON MATRIX PROGRAM IN CARVER COUNTY

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization
Address:
11065 VILLAGE ROAD
CHASKA, MN
ZIP 55318
Phone: (952) 960-9715
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THE SALVATION ARMY HARBOR LIGHT CENTER BEACON PROGRAM is a substance abuse rehabilitation facility in Chaska, 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. THE SALVATION ARMY HARBOR LIGHT CENTER BEACON PROGRAM NPI is 1487785234. The provider is registered as an organization entity type.
The provider Is Doing Business As Salvation Army Beacon Matrix Program In Carver County.

The provider's business location address is:

11065 VILLAGE ROAD
CHASKA, MN
ZIP 55318
Phone: (952) 960-9715
Fax: (952) 960-9714

The provider's authorized official is David Tinkis .
The authorized official title is Chief Operating Officer and has the following contact phone number (612) 767-3102.

The enumeration date for this NPI number is 3/7/2007 and was last updated on 8/22/2020.


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
1324500000XSubstance Abuse Rehabilitation Facility1042208-1-CDTMINNESOTAYes

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
1597555700MEDICAIDMINNESOTA

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: 5/5/2024

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