NPIMap

Organization Active NPI

The Salvation Army Harbor Light Center Beacon Program

  • Substance Abuse Rehabilitation Facility
  • Chaska, MN
National Provider Identifier
1487785234
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1042208-1-CDT Issued in MN
Legal business name
THE SALVATION ARMY HARBOR LIGHT CENTER BEACON PROGRAM
Practice address
11065 Village Road
Chaska, MN 55318
Phone
(952) 960-9715
Fax
(952) 960-9714
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
David Tinkis
Title
Chief Operating Officer
Phone
(612) 767-3102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 1042208-1-CDT MN Primary

Addresses

Primary practice location

11065 Village Road
Chaska, MN 55318

Mailing address

1010 Currie Ave
Minneapolis, MN 55403-1309
Phone (612) 338-0113

Other identifiers 1

IdentifierTypeStateIssuer
597555700MedicaidMN

Other names 1

  • Salvation Army Beacon Matrix Program in Carver County Doing business as

National Provider Directory

National Provider Directory
Tax ID family
The Salvation Army Harbor Light Center Beacon Program16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487785234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 CURRIE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554031309",
            "telephone_number": "612-338-0113",
            "fax_number": "612-338-4717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11065 VILLAGE ROAD",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "55318",
            "telephone_number": "952-960-9715",
            "fax_number": "952-960-9714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SALVATION ARMY HARBOR LIGHT CENTER BEACON PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TINKIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "612-767-3102"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1042208-1-CDT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597555700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salvation Army Beacon Matrix Program in Carver County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chaska, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.