CDC Centers, Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1066127 Issued in MN

Legal business name

CDC CENTERS, INC

Doing business as

Glen Creek Lodge

Practice address

5708 Glen Ave
Minnetonka, MN 55345-6611

Phone

(952) 894-7722

Fax

(952) 894-0882

NPI assigned

Jun 26, 2013

Organization subpart

No

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

Authorized official

Name

Ruth Carol Ackley, LADC

Title

Ceo

Phone

(952) 894-7722

Specialties & licenses 1

Addresses

Other names 1

• Glen Creek Lodge Doing business as

Tax ID family

CDC Centers4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• CDC Centers

  dba A Womans Way

  • Substance Abuse Rehabilitation Facility
  • Burnsville, MN
  • NPI 1124162094
  NPD tax ID
• CDC Centers

  dba River Ridge Treatment Center

  • Addiction (Substance Use Disorder) Counselor
  • Burnsville, MN
  • NPI 1215040605
  NPD tax ID
• CDC Centers

  dba River Ridge Treatment Center

  • Addiction (Substance Use Disorder) Counselor
  • Minnetonka, MN
  • NPI 1407961709
  NPD tax ID

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377475200000",
    "number": "1285074922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14750 LAC LAVON DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553066398",
            "telephone_number": "952-894-7722",
            "fax_number": "952-894-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5708 GLEN AVE",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553456611",
            "telephone_number": "952-894-7722",
            "fax_number": "952-894-0882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDC CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-08-26",
        "status": "A",
        "authorized_official_last_name": "ACKLEY",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-894-7722",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1066127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glen Creek Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Odalys Castrillo, ARNP
• Theodore Catanzaro
• James Joseph Cavanaugh, LADC
• Susan Elaine Cave, NP
• CDC Centers (River Ridge Treatment Center)
• Center for Women's Group Therapy
• Carole Gail Cera, LICSW
• Becky Cervenka
• Sonja Chafin, RN,CFNP
• Nathan A Champine, PA-C

• Substance Abuse Rehabilitation Facility in Minnetonka, MN
• Providers in Minnetonka, 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 Aug 26, 2013; 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.