Provider Demographics
NPI:1285074922
Name:CDC CENTERS, INC
Entity type:Organization
Organization Name:CDC CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:ACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:952-894-7722
Mailing Address - Street 1:14750 LAC LAVON DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6398
Mailing Address - Country:US
Mailing Address - Phone:952-894-7722
Mailing Address - Fax:952-894-0882
Practice Address - Street 1:5708 GLEN AVE
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-6611
Practice Address - Country:US
Practice Address - Phone:952-894-7722
Practice Address - Fax:952-894-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1066127324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility