NPIMap

Organization Active NPI

Minnesota Teen Challnge, Inc.

Doing business as Minnesota Adult and Teen Challenge- Life renewal

  • Substance Abuse Rehabilitation Facility
  • Brainerd, MN
National Provider Identifier
1649636689
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1078601-1-CDT Issued in MN
Legal business name
MINNESOTA TEEN CHALLNGE, INC.
Doing business as
Minnesota Adult and Teen Challenge- Life renewal
Practice address
313 Laurel St
Brainerd, MN 56401-3522
Phone
(218) 833-8758
Fax
(218) 828-6932
NPI assigned
Jan 6, 2016
Last updated
Jan 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

Name
Mr. James Vincent Lange, LADCNPI 1285547745
Title
Treatment Director
Phone
(218) 833-8758

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 1078601-1-CDT MN Primary

Addresses

Primary practice location

313 Laurel St
Brainerd, MN 56401-3522

Mailing address

1619 Portland Ave
Minneapolis, MN 55404-1507
Phone (218) 833-8777

Other names 1

  • Minnesota Adult and Teen Challenge- Life renewal Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Teen Challnge Inc13 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.

Locations

313 Laurel St
Brainerd, MN 56401
Phone (218) 833-8758

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": "1452038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1649636689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041507",
            "telephone_number": "218-833-8777",
            "fax_number": "218-828-6932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 LAUREL ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013522",
            "telephone_number": "218-833-8758",
            "fax_number": "218-828-6932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA TEEN CHALLNGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-06",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "LANGE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "TREATMENT DIRECTOR",
        "authorized_official_telephone_number": "218-833-8758",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1078601-1-CDT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Adult and Teen Challenge- Life renewal",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.