New Salem Metormorphosis Youth Program

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

NEW SALEM METORMORPHOSIS YOUTH PROGRAM

Doing business as

New Salem Metormorphosis youth program

Practice address

2509 Bryant Ave North
Minneapolis, MN 55411

Phone

(612) 250-8799

Fax

(612) 529-9416

NPI assigned

Mar 30, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Hortenese Nene Jones, BA

Title

Program Administrator

Phone

(612) 250-8799

Specialties & licenses 2

Addresses

Other names 1

• New Salem Metormorphosis youth program Doing business as

Tax ID family

New Salem Metamorphosis Adolesent Program2 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.

• New Salem Metamorphosis Adolesent Program

  • Addiction (Substance Use Disorder) Counselor
  • Minneapolis, MN
  • NPI 1750636973
  NPD tax ID

Locations

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1720354004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 BRYANT AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112116",
            "telephone_number": "612-250-8799",
            "fax_number": "612-529-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2509 BRYANT AVE NORTH",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55411",
            "telephone_number": "612-250-8799",
            "fax_number": "612-529-9416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW SALEM METORMORPHOSIS YOUTH PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "HORTENESE",
        "authorized_official_middle_name": "NENE",
        "authorized_official_title_or_position": "PROGRAM ADMINISTRATOR",
        "authorized_official_telephone_number": "612-250-8799",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "301674",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Salem Metormorphosis youth program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• New Horizon Therapy Center LLC
• New Horizons Health Center
• New Millennium Academy
• New Minnesota Purpose of Freedom
• New Salem Metamorphosis Adolesent Program
• New Salem Missionary Baptist Church (New Youth ReDevelopment)
• New Vision Mental Health Inc
• New Visions School
• New Youth Program
• Alexis Marie Newberry, MD

• Addiction (Substance Use Disorder) Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.