Provider Demographics
NPI:1487715033
Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-BAXTER
Entity type:Organization
Organization Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-BAXTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-431-3693
Mailing Address - Street 1:3200 LABORE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5186
Mailing Address - Country:US
Mailing Address - Phone:651-431-5995
Mailing Address - Fax:651-431-7505
Practice Address - Street 1:14241 GRAND OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-316-3101
Practice Address - Fax:218-829-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN644633000Medicaid
MN644633000Medicaid