Doctor Name: | CORRIE JOESPH PELTIER |
NPI Number: | 1114070406 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC |
License Number: | 1032392-1-CDT |
Business Practice Address: | 31065 Forest Blvd. Stacy, MN - 55079 |
Business Phone Number: | 6504087121 |
Business Fax Number: | |
Mailing Address: | Po Box 30, STACY |
State: | MN |
Postal Code: | 550790030 |
Phone Number: | 6514087121 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 1032392-1-CDT |
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. |