Organization
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Active
Organization
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Active
Other names
Annandale Intensive Residential Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J. BARAGA PH.D., LP (EXECUTIVE DIRECTOR)
(320) 252-5010
Entity
Organization
Contact information
Practice address
380 ANNANDALE BLVD, ANNANDALE, MN 55302
(320) 274-4050
(320) 274-4069
Mailing address
1321 13TH ST N, SAINT CLOUD, MN 56303-2613
(320) 252-5010
(320) 203-1855
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
FBL-0020515-25193
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FBL-0020515-25193
DEPART OF HEALTH LICENSE
MN
Enumeration date
10/01/2007
Last updated
08/05/2009
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