Prodigal House Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

801974 Issued in MN

Legal business name

PRODIGAL HOUSE INC.

Practice address

5103 Minnehaha Ave BLDG 16
Minneapolis, MN 55417-1647

Phone

(612) 721-3358

Fax

(612) 721-2619

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Amelia Merlinda Grein, BS, LADC

Title

Executive Director

Phone

(612) 721-8556

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1316016884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5103 MINNEHAHA AVE BLDG 16",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647",
            "telephone_number": "612-721-3358",
            "fax_number": "612-721-2619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5103 MINNEHAHA AVE BLDG 16",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647",
            "telephone_number": "612-721-3358",
            "fax_number": "612-721-2619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGAL HOUSE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "GREIN",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_middle_name": "MERLINDA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-721-8556",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BS, LADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "801974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.