Organization
RIVERPLACE COUNSELING CENTERS INC
Active
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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