NPIMap

Organization Active NPI

Minnesota Teen Challenge, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Alexandria, MN
National Provider Identifier
1700567682
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
MINNESOTA TEEN CHALLENGE, INC
Practice address
625 Broadway St
Alexandria, MN 56308-1663
Phone
(612) 373-3366
Fax
(612) 333-4111
NPI assigned
Jul 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Authorized official

Name
Stephanie Beaulieu
Title
Contract Representative
Phone
(612) 373-3366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

625 Broadway St
Alexandria, MN 56308-1663

Mailing address

740 E 24TH St
Minneapolis, MN 55404-3862
Phone (612) 373-3366

Other names 1

  • Minnesota Adult & Teen Challenge Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Teen Challenge13 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

625 Broadway St
Alexandria, MN 56308

NPI Registry JSON

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1700567682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 E 24TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043862",
            "telephone_number": "612-373-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 BROADWAY ST",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563081663",
            "telephone_number": "612-373-3366",
            "fax_number": "612-333-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA TEEN CHALLENGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "BEAULIEU",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CONTRACT REPRESENTATIVE",
        "authorized_official_telephone_number": "612-373-3366"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Adult & Teen Challenge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alexandria, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.