Northstar Behavioral Health Cranberry Acres, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1083755 Issued in MN

Legal business name

NORTHSTAR BEHAVIORAL HEALTH CRANBERRY ACRES, LLC

Practice address

5810 Cranberry Dr
Wyoming, MN 55092-9499

Phone

(612) 749-8751

NPI assigned

Dec 29, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Wendy Kay Stewart, MA, LADC

Title

Owner / Executive Director

Phone

(612) 749-8751

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482969600000",
    "number": "1265977284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 CRANBERRY DR",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550929499",
            "telephone_number": "612-749-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5810 CRANBERRY DR",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550929499",
            "telephone_number": "612-749-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR BEHAVIORAL HEALTH CRANBERRY ACRES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-29",
        "last_updated": "2016-12-29",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OWNER / EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-749-8751",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1083755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Douglas Nelson, R. PH.
• Daniel Rupert Neren, MD
• Sue Nielsen, MD
• Jennifer Norstrem, LISW
• North Metro Anesthesia Services P.a.
• Maria Teresa Ocasio Carle, M.D.
• Barbara Ollmann, MT-BC
• Ryan Olmscheid, DPT, OCS
• Christina Marie Orde
• James Orton, PA-C

• Substance Abuse Rehabilitation Facility in Wyoming, MN
• Providers in Wyoming, MN by specialty
• Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2016; 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.