| Organization Name: | MICAH HOUSE |
| NPI Number: | 1093190258 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTHONY SCOTT HOLMQUIST-BURKS (CLINICAL SUPERVISOR) |
| Mailing Address: | 3047 5th Ave S Minneapolis |
| State: | MN US |
| Postal Code: | 554082415 |
| Phone Number: | 6518270484 |
| Fax Number: | 6128270485 |
| NPI Enumeration Date: | 07/29/2015 |
| NPI Last Update Date: | 07/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | 303472 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |