NPIMap

Organization Active NPI

Central Minnesota Mental Health Center

Doing business as Northway Intensive Residential Treatment

  • Mental Illness Community Based Residential Treatment Facility
  • Saint Cloud, MN
National Provider Identifier
1225016306
Registry record updated Aug 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
801767-1-RMI Issued in MN
Legal business name
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Doing business as
Northway Intensive Residential Treatment
Practice address
1509 24TH Ave N
Saint Cloud, MN 56303-1306
Phone
(320) 252-8648
Fax
(320) 529-4909
NPI assigned
Jan 9, 2006
Last updated
Aug 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2009

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

Authorized official

Name
Dr. David J. Baraga, PH.D., LPNPI 1679519789
Title
Executive Director
Phone
(320) 252-5010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 801767-1-RMI MN Primary

Addresses

Primary practice location

1509 24TH Ave N
Saint Cloud, MN 56303-1306

Mailing address

1321 13TH St N
Saint Cloud, MN 56303-2613
Phone (320) 252-5010

Other identifiers 1

IdentifierTypeStateIssuer
640902400MedicaidMN

Other names 1

  • Northway Intensive Residential Treatment Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000248 MN Part B Supplier - Clinic/Group Practice 4486555877 Receives reassigned benefits from 47 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monticello, MN; Waite Park, MN; Saint Cloud, MN; Elk River, MN; Buffalo, MN

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249430400000",
    "number": "1225016306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 13TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032613",
            "telephone_number": "320-252-5010",
            "fax_number": "320-203-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 24TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031306",
            "telephone_number": "320-252-8648",
            "fax_number": "320-529-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2009-08-05",
        "status": "A",
        "authorized_official_last_name": "BARAGA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "320-252-5010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LP"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MN",
            "license": "801767-1-RMI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "640902400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northway Intensive Residential Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.