NEW SALEM METORMORPHOSIS YOUTH PROGRAM NPI 1720354004

NPI Information

NEW SALEM METORMORPHOSIS YOUTH PROGRAM is an addiction (substance use disorder) counselor in Minneapolis, MN. NEW SALEM METORMORPHOSIS YOUTH PROGRAM NPI is 1720354004. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As New Salem Metormorphosis Youth Program.

The provider's business location address is:

2509 BRYANT AVE NORTH
MINNEAPOLIS, MN
ZIP 55411
Phone: (612) 250-8799
Fax: (612) 529-9416

The provider's authorized official is Hortenese Nene Jones .
The authorized official title is Program Administrator and has the following contact phone number (612) 250-8799.

The enumeration date for this NPI number is 3/30/2012 and was last updated on 3/30/2012.

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:

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