Provider Demographics
NPI:1154895977
Name:NORTHSTAR BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NORTHSTAR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANROEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-487-4987
Mailing Address - Street 1:1932 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3426
Mailing Address - Country:US
Mailing Address - Phone:651-772-4957
Mailing Address - Fax:651-488-0887
Practice Address - Street 1:5713 GENEVA AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128
Practice Address - Country:US
Practice Address - Phone:651-371-7327
Practice Address - Fax:651-488-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility