NPIMap

Organization Active NPI

Micah House

  • Substance Abuse Rehabilitation Facility
  • Minneapolis, MN
National Provider Identifier
1093190258
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
303472 Issued in MN
Legal business name
MICAH HOUSE
Practice address
3047 5TH Ave S
Minneapolis, MN 55408-2415
Phone
(651) 827-0484
Fax
(612) 827-0485
NPI assigned
Jul 29, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anthony Scott Holmquist-Burks, LADC
Title
Clinical Supervisor
Phone
(612) 827-0484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 303472 MN Primary

Addresses

Primary practice location

3047 5TH Ave S
Minneapolis, MN 55408-2415

Mailing address

3047 5TH Ave S
Minneapolis, MN 55408-2415
Phone (651) 827-0484

Other identifiers 1

IdentifierTypeStateIssuer
303472MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Victory Through Faith Recovery Servies3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1093190258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3047 5TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082415",
            "telephone_number": "651-827-0484",
            "fax_number": "612-827-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3047 5TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082415",
            "telephone_number": "651-827-0484",
            "fax_number": "612-827-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICAH HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "HOLMQUIST-BURKS",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "612-827-0484",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "303472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "303472",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.