Provider Demographics
NPI:1619196524
Name:CENTER FOR ALCOHOL AND DRUG TREATMENT, INC.
Entity type:Organization
Organization Name:CENTER FOR ALCOHOL AND DRUG TREATMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SILVERNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MAM, LADC, LSW
Authorized Official - Phone:218-529-3426
Mailing Address - Street 1:314 W SUPERIOR ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1892
Mailing Address - Country:US
Mailing Address - Phone:218-723-8444
Mailing Address - Fax:218-529-3440
Practice Address - Street 1:314 W SUPERIOR ST STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1892
Practice Address - Country:US
Practice Address - Phone:218-723-8444
Practice Address - Fax:218-529-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN788855400OtherSTATE OF MN, DHS, CD FUND
MN795255400OtherSTATE OF MN, DHS, CD FUND
MN4C48DUOtherBLUE CROSS BLUE SHIELD MN
MN8097HOOtherBLUE CROSS BLUE SHIELD MN
MN122711OtherUCARE MINNESOTA
MN195105000OtherSTATE OF MN, DHS, CD FUND
MN398755800OtherSTATE OF MN, DHS, CD FUND
MN657623100OtherSTATE OF MN, DHS, CD FUND
MN7C04CEOtherBLUE CROSS BLUE SHIELD MN
MN048755400OtherSTATE OF MN, DHS, CD FUND
MN588756900OtherSTATE OF MN, DHS, CD FUND
MN9068CEOtherBLUE CROSS BLUE SHIELD MN