Provider Demographics
NPI:1528145638
Name:COMMUNITY DRUG & ALCOHOL SERVICES INC
Entity type:Organization
Organization Name:COMMUNITY DRUG & ALCOHOL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT LADC
Authorized Official - Phone:952-564-3000
Mailing Address - Street 1:151 W BURNSVILLE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2524
Mailing Address - Country:US
Mailing Address - Phone:952-564-3000
Mailing Address - Fax:952-847-4966
Practice Address - Street 1:501EAST HWY 13
Practice Address - Street 2:SUITE 108
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-564-3000
Practice Address - Fax:952-564-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN87726OtherUNITED HC
167105OtherUCARE
MN167105OtherBHP/UCARE
MN943127600Medicaid
MN1007386OtherDHS LICENSE
MN060113009OtherMETROPOLITAN HP
MN4D45COOtherBCBS
MN82482OtherHEALTH PARTNERS
MN12637OtherDAKOTA COUNTY RULE 25 CONTRACT
MN060113009OtherMAGELLAN