Provider Demographics
NPI:1790966828
Name:COMMUNITY TRANSITIONAL SERVICES-EVELETH
Entity type:Organization
Organization Name:COMMUNITY TRANSITIONAL SERVICES-EVELETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH ADMIN OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KORNRUMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-431-5003
Mailing Address - Street 1:PO BOX 64979
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164-0979
Mailing Address - Country:US
Mailing Address - Phone:651-431-3676
Mailing Address - Fax:
Practice Address - Street 1:227 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-1606
Practice Address - Country:US
Practice Address - Phone:218-744-7436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness