NPIMap

Organization Active NPI

Wild River Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Saint Paul, MN
National Provider Identifier
1285095778
Registry record updated Jan 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
1084328 Issued in MN
Legal business name
WILD RIVER SERVICES
Doing business as
The Heights University
Practice address
1246 University Ave W Ste 101
Saint Paul, MN 55104-4125
Phone
(651) 558-9522
NPI assigned
Mar 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2017

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

Authorized official

Name
Colin Kelly Faulkner
Title
Executive Director
Phone
(651) 558-9522

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1080800 MN
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1084328 MN Primary

Addresses

Primary practice location

1246 University Ave W Ste 101
Saint Paul, MN 55104-4125

Mailing address

1246 University Ave W Ste 101
Saint Paul, MN 55104-4125
Phone (651) 558-9522

Other names 1

  • The Heights University Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wild River Services4 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1457654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1285095778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 UNIVERSITY AVE W STE 101",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044125",
            "telephone_number": "651-558-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 UNIVERSITY AVE W STE 101",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044125",
            "telephone_number": "651-558-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD RIVER SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-11",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "COLIN",
        "authorized_official_middle_name": "KELLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-558-9522"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "1080800",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "1084328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Heights University",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; 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.