NPIMap

Organization Active NPI

Minnesota Teen Challenge

Doing business as Minnesota Adult & Teen Challenge

  • Substance Abuse Rehabilitation Facility
  • Rochester, MN
National Provider Identifier
1336658277
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
Doing business as
Minnesota Adult & Teen Challenge
Practice address
1542 Assisi Drive NW
Rochester, MN 55901
Phone
(612) 373-3366
Fax
(612) 333-4111
NPI assigned
Sep 22, 2017
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
Debra Rae Warner
Title
Billing Manager
Phone
(612) 238-6528

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X MN
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1542 Assisi Drive NW
Rochester, MN 55901

Mailing address

740 E 24TH St
Minneapilis, MN 55404
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 Challenge13 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.

NPI Registry JSON

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

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1336658277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 E 24TH ST",
            "city": "MINNEAPILIS",
            "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": "1542 ASSISI DRIVE NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "55901",
            "telephone_number": "612-373-3366",
            "fax_number": "612-333-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA TEEN CHALLENGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-22",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "612-238-6528"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "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.