Organization Name: | CANVAS HEALTH, INC. |
NPI Number: | 1104993302 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MATTHEW M. EASTWOOD (COO) |
Mailing Address: | 8451 E Point Douglas Rd S Cottage Grove |
State: | MN US |
Postal Code: | 550163331 |
Phone Number: | 6514584116 |
Fax Number: | 6514585632 |
NPI Enumeration Date: | 11/30/2006 |
NPI Last Update Date: | 02/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 801109 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |