Organization Name: | PRODIGAL HOUSE INC. |
NPI Number: | 1316016884 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMELIA MERLINDA GREIN (EXECUTIVE DIRECTOR) |
Mailing Address: | 5103 Minnehaha Ave Bldg 16 Minneapolis |
State: | MN US |
Postal Code: | 554171647 |
Phone Number: | 6127213358 |
Fax Number: | 6127212619 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 06/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 801974 |
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. |