Organization
RIVERPLACE COUNSELING CENTERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANNON ELIZABETH BOOKWALTER LIC ALCOHOL AND DRUG (ADMINISTRATOR)
(763) 427-9777
Entity
Organization
Contact information
Practice address
6058 HIGHWAY 10 NW, ANOKA, MN 55303-4530
(763) 421-5590
(763) 427-6876
Mailing address
6058 HIGHWAY 10 NW, ANOKA, MN 55303-4530
(763) 421-5590
(763) 427-6876
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
8061421CDT
MN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
8083761CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0949
REVENUE CODE
MN
01
—
1247315
STATE
—
01
—
H2035
PROC CODE
MN
Enumeration date
03/30/2007
Last updated
08/30/2019
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