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Organization
NEW DIRECTIONS FOR CHANGE
Active
Organization
NEW DIRECTIONS FOR CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARLAND P FANNING (TREATMENT DIRECTOR)
(612) 414-4814
Entity
Organization
Contact information
Practice address
6500 BROOKLYN BLVD - LOWER LEVEL, BROOKLYN CENTER, MN 55429
(612) 414-4814
(952) 938-5014
Mailing address
6500 BROOKLYN BLVD STE 103, BROOKLYN CENTER, MN 55429-1755
(612) 414-4814
(952) 938-5014
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
10/31/2011
Last updated
10/31/2011
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