NPIMap

Organization Active NPI

Canvas Health, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Cottage Grove, MN
National Provider Identifier
1104993302
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
801109 Issued in MN
Legal business name
CANVAS HEALTH, INC.
Practice address
8451 E Point Douglas Rd S
Cottage Grove, MN 55016-3331
Phone
(651) 458-4116
Fax
(651) 458-5632
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Authorized official

Name
Matthew M. Eastwood, PH.D., MPA, LMFT
Title
Coo
Phone
(651) 777-5222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 801109 MN Primary

Addresses

Primary practice location

8451 E Point Douglas Rd S
Cottage Grove, MN 55016-3331

Mailing address

7066 Stillwater Blvd N
Oakdale, MN 55128-3937
Phone (651) 777-5222

Other identifiers 1

IdentifierTypeStateIssuer
353302600MedicaidMN

Other names 1

  • Human Services, Inc. in Washington County Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Canvas Health Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

8451 E Point Douglas Rd S
Cottage Grove, MN 55016
Phone (651) 459-3171

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1104993302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7066 STILLWATER BLVD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551283937",
            "telephone_number": "651-777-5222",
            "fax_number": "651-251-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8451 E POINT DOUGLAS RD S",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550163331",
            "telephone_number": "651-458-4116",
            "fax_number": "651-458-5632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANVAS HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "EASTWOOD",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "651-777-5222",
        "authorized_official_credential": "PH.D., MPA, LMFT"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "801109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "353302600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Human Services, Inc. in Washington County",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cottage Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.