NPIMap

Organization Active NPI

Kidspeace Mesabi Academy

  • Community/Behavioral Health Agency
  • Buhl, MN
National Provider Identifier
1427410844
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1075006 Issued in MN
Legal business name
KIDSPEACE MESABI ACADEMY
Practice address
200 Wanless Street
Buhl, MN 55713-0726
Phone
(218) 258-2274
Fax
(218) 258-2311
NPI assigned
Mar 24, 2016
Last updated
Mar 30, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
KIDSPEACE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name
Mr. Paul Jacobson, MBA
Title
Executive Director
Phone
(218) 258-2311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1075006 MN Primary

Addresses

Primary practice location

200 Wanless Street
Buhl, MN 55713-0726

Mailing address

PO Box 726
200 Wanless Street
Buhl, MN 55713-0726
Phone (218) 258-2274

Other names 1

  • Mesabi Community Counseling Other name

National Provider Directory

National Provider Directory
Tax ID family
Kidspeace Mesabi Academy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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, 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": "1458777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1427410844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 726",
            "address_2": "200 WANLESS STREET",
            "city": "BUHL",
            "state": "MN",
            "postal_code": "557130726",
            "telephone_number": "218-258-2274",
            "fax_number": "218-258-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WANLESS STREET",
            "city": "BUHL",
            "state": "MN",
            "postal_code": "557130726",
            "telephone_number": "218-258-2274",
            "fax_number": "218-258-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSPEACE MESABI ACADEMY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDSPEACE, INC.",
        "enumeration_date": "2016-03-24",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "218-258-2311",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "1075006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesabi Community Counseling",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Buhl, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; 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.