NPIMap

Organization Active NPI

Canvas Health, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Forest Lake, MN
National Provider Identifier
1528129574
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
801109 Issued in MN
Legal business name
CANVAS HEALTH, INC.
Practice address
121 11TH Ave SE
Forest Lake, MN 55025-1850
Phone
(651) 251-5220
Fax
(651) 251-5279
NPI assigned
Dec 13, 2006
Last updated
Feb 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Authorized official

Name
Matthew M. Eastwood, PH.D., MPA, LMFT
Title
Coo
Phone
(651) 777-5222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 801109 MN Primary

Addresses

Primary practice location

121 11TH Ave SE
Forest Lake, MN 55025-1850

Mailing address

7066 Stillwater Blvd N
Oakdale, MN 55128-3937
Phone (651) 777-5222

Other identifiers 1

IdentifierTypeStateIssuer
353302600MedicaidMN

Other names 1

  • Human Services, Inc. in Washington County Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Canvas Health Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1528129574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7066 STILLWATER BLVD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551283937",
            "telephone_number": "651-777-5222",
            "fax_number": "651-251-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 11TH AVE SE",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550251850",
            "telephone_number": "651-251-5220",
            "fax_number": "651-251-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANVAS HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "EASTWOOD",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "651-777-5222",
        "authorized_official_credential": "PH.D., MPA, LMFT"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "801109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "353302600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Human Services, Inc. in Washington County",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Forest Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.