Organization
MINNESOTA TEEN CHALLENGE, INC.
Active
Other names
Minnesota Adult & Teen Challenge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL WILLIAM MAHONEY LADC, NCAC1 (TREATMENT DIRECTOR)
(507) 218-3450
Entity
Organization
Contact information
Practice address
1530 ASSISI DR NW, ROCHESTER, MN 55901
(507) 288-3733
(855) 288-8560
Mailing address
1619 PORTLAND AVE S, MINNEAPOLIS, MN 55404
(612) 373-3366
(612) 333-4111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
302F00000X
Exclusive Provider Organization
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/22/2014
Last updated
03/14/2022
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