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Organization

FIRST STEP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAN JEAN JOHNSON (EXECUTIVE DIRECTOR)
(218) 947-3543
Entity
Organization

Contact information

Practice address
222 CARPENTER ST, BACKUS, MN 56435-2209
(218) 947-3543
(218) 947-3549
Mailing address
222 CARPENTER ST, BACKUS, MN 56435-2209
(218) 947-3543
(218) 947-3549

Taxonomy

Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
1055720
MN

Other

Enumeration date
12/18/2009
Last updated
12/18/2009
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