NPIMap

Organization Active NPI

Minnesota Teen Challenge, Inc.

Doing business as Minnesota Adult & Teen Challenge

  • Substance Abuse Rehabilitation Facility
  • Crystal, MN
National Provider Identifier
1154977056
Registry record updated Dec 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
MINNESOTA TEEN CHALLENGE, INC.
Doing business as
Minnesota Adult & Teen Challenge
Practice address
2756 Douglas Dr N
Crystal, MN 55422-2402
Phone
(612) 373-3366
NPI assigned
Aug 15, 2019
Last updated
Dec 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2022

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

Authorized official

Name
Sadie Twite
Title
Revenue Cycle Director
Phone
(612) 373-3366

Specialties & licenses 1

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

Addresses

Primary practice location

2756 Douglas Dr N
Crystal, MN 55422-2402

Mailing address

740 E 24TH St
Minneapolis, MN 55404-3862
Phone (763) 257-5301

Other practice location 1

2365 Ariel St N
Maplewood, MN 55109-2248
Phone (612) 373-3366

Other names 1

  • Minnesota Adult & Teen Challenge Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Teen Challenge13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

2365 Ariel St N
Saint Paul, MN 55109
Phone (612) 777-8987

NPI Registry JSON

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670889600000",
    "number": "1154977056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 E 24TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043862",
            "telephone_number": "763-257-5301",
            "fax_number": "763-322-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2756 DOUGLAS DR N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554222402",
            "telephone_number": "612-373-3366"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2365 Ariel St N",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551092248",
            "country_code": "US",
            "telephone_number": "612-373-3366",
            "fax_number": "612-333-4111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINNESOTA TEEN CHALLENGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A",
        "authorized_official_last_name": "TWITE",
        "authorized_official_first_name": "SADIE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "612-373-3366"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Adult & Teen Challenge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minnesota Adult & Teen Challenge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.