Acres for Life Therapy & Wellness Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

19404 Issued in MN

Legal business name

ACRES FOR LIFE THERAPY & WELLNESS CENTER

Practice address

12058 55TH St N
Stillwater, MN 55082-2029

Phone

(651) 257-4159

NPI assigned

Jul 22, 2016

Organization subpart

No

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

Authorized official

Name

Lynn Marie Moore, MA LADC

Title

President

Phone

(651) 257-4159

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Acres for Life Therapy Wellness Center2 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.

• Acres for Life Therapy & Wellness Center

  • Counselor
  • Chisago City, MN
  • NPI 1053702910
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lynn Marie Fagen Moore

  • Addiction (Substance Use Disorder) Counselor
  • Chisago City, MN
  • NPI 1245519388
  NPD

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469145600000",
    "number": "1669825857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12058 55TH ST N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550822029",
            "telephone_number": "651-257-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12058 55TH ST N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550822029",
            "telephone_number": "651-257-4159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACRES FOR LIFE THERAPY & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-22",
        "last_updated": "2016-07-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-257-4159",
        "authorized_official_credential": "MA LADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "19404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD OF MINNESOTA",
            "identifier": "8JM77AC",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA HEALTH CARE PROGRAM",
            "identifier": "1053702910",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Naema Suleiman Abdulkadir
• Abijah'S Hope
• April D Abrahamson, MD
• Hayley Ann Abram
• Jessica Acker, FNP-C
• Beth Allison Adams, MD
• Christine J Adams
• Michael Brian Adams, MD
• Advanced Dermatology Care Medical Cosmetic and Surgery PA
• Nichole Margaret Aguilera Torres, LICSW

• All providers in Stillwater, MN
• Community/Behavioral Health Agency in Minnesota

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