Provider Demographics
NPI:1154977056
Name:MINNESOTA TEEN CHALLENGE, INC.
Entity type:Organization
Organization Name:MINNESOTA TEEN CHALLENGE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TWITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-373-3366
Mailing Address - Street 1:740 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3862
Mailing Address - Country:US
Mailing Address - Phone:763-257-5301
Mailing Address - Fax:763-322-0152
Practice Address - Street 1:2756 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2402
Practice Address - Country:US
Practice Address - Phone:612-373-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty