Organization
ON-BELAY OF MN INCORPORATED
Active
Other names
Anthony Louis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARCEY THEIS (OFFICE MANAGER)
(763) 367-6981
Entity
Organization
Contact information
Practice address
115 FORESTVIEW LANE, PLYMOUTH, MN 55441
(763) 542-9212
Mailing address
115 FORESTVIEW LANE, PLYMOUTH, MN 55441
(763) 542-9212
(763) 542-9248
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
5228577
MN
Other
Enumeration date
03/31/2006
Last updated
10/26/2011
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