NPIMap

Organization Active NPI

Community Options Fridley Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Fridley, MN
National Provider Identifier
1154441491
Registry record updated May 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
COMMUNITY OPTIONS FRIDLEY INC.
Practice address
5384 5TH St NE
Fridley, MN 55421-1108
Phone
(763) 572-0009
Fax
(763) 572-1295
NPI assigned
Mar 30, 2007
Last updated
May 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2013

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

Authorized official

Name
Diane M Ollendick Wright, LICSW
Title
Executive Director
Phone
(763) 277-1038

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

5384 5TH St NE
Fridley, MN 55421-1108

Mailing address

5384 5TH St NE
Fridley, MN 55421-1108
Phone (763) 572-0009

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369353600000",
    "number": "1154441491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5384 5TH ST NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211108",
            "telephone_number": "763-572-0009",
            "fax_number": "763-572-1295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5384 5TH ST NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211108",
            "telephone_number": "763-572-0009",
            "fax_number": "763-572-1295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY OPTIONS FRIDLEY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2013-05-24",
        "status": "A",
        "authorized_official_last_name": "OLLENDICK WRIGHT",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "763-277-1038",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; 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.