NPIMap

Organization Active NPI

Minnesota Teen Challenge, Inc.

Doing business as Minnesota Adult & Teen Challenge

  • Substance Abuse Rehabilitation Facility
  • Rochester, MN
National Provider Identifier
1285057539
Registry record updated Mar 14, 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
1530 Assisi Dr NW
Rochester, MN 55901
Phone
(507) 288-3733
Fax
(855) 288-8560
NPI assigned
Jan 22, 2014
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Mr. Michael William Mahoney, LADC, NCAC1NPI 1659799500
Title
Treatment Director
Phone
(507) 218-3450

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X NU
Substance Abuse Rehabilitation Facility 324500000X NU Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU

Addresses

Primary practice location

1530 Assisi Dr NW
Rochester, MN 55901

Mailing address

1619 Portland Ave S
Minneapolis, MN 55404
Phone (612) 373-3366

Other practice location 1

40 16th St SE Ste E
Rochester, MN 55904-7987
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 Challenge Inc13 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

1619 Portland Ave
Minneapolis, MN 55404
Phone (612) 238-6273

Practitioners & affiliated clinicians

Practitioners 1

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": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1285057539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 PORTLAND AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55404",
            "telephone_number": "612-373-3366",
            "fax_number": "612-333-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 ASSISI DR NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "55901",
            "telephone_number": "507-288-3733",
            "fax_number": "855-288-8560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 16th St SE Ste E",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559047987",
            "country_code": "US",
            "telephone_number": "612-373-3366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINNESOTA TEEN CHALLENGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "MAHONEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "TREATMENT DIRECTOR",
        "authorized_official_telephone_number": "507-218-3450",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LADC, NCAC1"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Rochester, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.