Provider Demographics
NPI:1528253978
Name:STILLE HAVN HUS INCORPORATED
Entity type:Organization
Organization Name:STILLE HAVN HUS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-547-5920
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-0530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 WALKER INDUSTRIES BOULEVARD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-0530
Practice Address - Country:US
Practice Address - Phone:218-547-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1032841-1-AFC320800000X
MN1032842-1-AFC320800000X
MN1032839-1-AFC320800000X
MN1032840-1-AFC320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness