Organization
RS EDEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE JOHNSON (CO-PRESIDENT AND CEO)
(612) 287-1619
Entity
Organization
Contact information
Practice address
1025 PORTLAND AVE, MINNEAPOLIS, MN 55404-1449
(612) 338-0723
(612) 338-3653
Mailing address
1931 W BROADWAY AVE, SUITE 101, MINNEAPOLIS, MN 55411-2400
(612) 287-1600
(612) 287-1616
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
10033342CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
682608300
—
MN
Enumeration date
11/02/2006
Last updated
08/18/2025
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