NPIMap

Organization Active NPI

Wild River Services Inc

  • Substance Abuse Rehabilitation Facility
  • Saint Paul, MN
National Provider Identifier
1467961193
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
WILD RIVER SERVICES INC
Doing business as
The Heights - Jackson
Practice address
1394 Jackson St
Saint Paul, MN 55117
Phone
(651) 558-9522
NPI assigned
Sep 26, 2017
Organization subpart
Yes
Parent organization
WILD RIVER SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1394 Jackson St
Saint Paul, MN 55117

Mailing address

1394 Jackson St Ste 300
Saint Paul, MN 55117-4629
Phone (651) 558-9522

Other names 1

  • The Heights - Jackson Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wild River Services4 organizations share this tax ID, including this one
Part of
Wild River Services

Other organizations with this tax ID 3

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

Locations

1394 Jackson St
Ste 300
Saint Paul, MN 55117
Phone (651) 478-7815

NPI Registry JSON

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

{
    "created_epoch": "1506384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531180800000",
    "number": "1467961193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1394 JACKSON ST STE 300",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551174629",
            "telephone_number": "651-558-9522",
            "fax_number": "651-207-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1394 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55117",
            "telephone_number": "651-558-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD RIVER SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILD RIVER SERVICES INC",
        "enumeration_date": "2017-09-26",
        "last_updated": "2018-07-10",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "COLIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-558-9522"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Heights - Jackson",
            "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 Jul 10, 2018; 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.