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Organization Active NPI

Community Behavioral Health Hospital Annandale

Doing business as CBHH Annandale

  • Psychiatric Hospital
  • Annandale, MN
National Provider Identifier
1225130487
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
333657 Issued in MN
Legal business name
COMMUNITY BEHAVIORAL HEALTH HOSPITAL ANNANDALE
Doing business as
CBHH Annandale
CBHH-Annandale
Practice address
400 Annandale Blvd.
Annandale, MN 55302
Phone
(651) 259-3850
NPI assigned
Sep 1, 2006
Last updated
Sep 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
Lynn Glancey
Title
Cfo
Phone
(651) 539-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 333657 MN Primary

Addresses

Primary practice location

400 Annandale Blvd.
Annandale, MN 55302

Mailing address

3200 Labore Rd Ste 104
Vadnais Heights, MN 55110-5186

Other identifiers 1

IdentifierTypeStateIssuer
166945000MedicaidMN

Other names 2

  • CBHH Annandale Doing business as
  • CBHH-Annandale Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070609000080 MN Part A Provider - Hospital 7113025453 Practice locations: Annandale, MN
O20250107001844 MN Part B Supplier - Hospital Department(S) 7113025453 Receives reassigned benefits from 14 practitioners
Practice locations: Annandale, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225130487. Details of each certification follow.

Hospital certification: CCN 244011

Legal name
COMMUNITY BEHAVIORAL HEALTH HOSPITAL-ANNANDALE
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Aug 21, 2008
Last certification
Jun 25, 2009
Beds
16
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
400 Annandale Blvd
Annandale, MN 55302-3141
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Behavioral Health Hospital AnnandaleCCN 244011 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
State of Minnesota - Minnesota Management and Budget Organization, St Paul, MN 5% Or Greater Direct Ownership Interest Aug 8, 2006
Wade R Brost Individual Operational/Managerial ControlInterim Executive Director May 22, 2013 100%
Lynn Marie Glancey Individual Corporate OfficerCfo Jul 1, 2025
W-2 Managing Employee Jul 1, 2025

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 11

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1225130487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 LABORE RD STE 104",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ANNANDALE BLVD.",
            "city": "ANNANDALE",
            "state": "MN",
            "postal_code": "55302",
            "telephone_number": "651-259-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BEHAVIORAL HEALTH HOSPITAL ANNANDALE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "GLANCEY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-539-7200"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "MN",
            "license": "333657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166945000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CBHH Annandale",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CBHH-Annandale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Annandale, MN

Sources for this page

Verify at the official NPI Registry.