Organization
ACRES FOR LIFE THERAPY & WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN MARIE MOORE MA LADC (PRESIDENT)
(651) 257-4159
Entity
Organization
Contact information
Practice address
12058 55TH ST N, STILLWATER, MN 55082-2029
(651) 257-4159
Mailing address
12058 55TH ST N, STILLWATER, MN 55082-2029
(651) 257-4159
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
19404
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053702910
MINNESOTA HEALTH CARE PROGRAM
MN
01
—
8JM77AC
BLUECROSS BLUESHIELD OF MINNESOTA
MN
Enumeration date
07/22/2016
Last updated
07/22/2016
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