Organization
JUEL FAIRBANKS CHEMICAL DEPENDENCY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE LINDSTROM (EXECUTIVE DIRECTOR)
(651) 282-0460
Entity
Organization
Contact information
Practice address
804 ALBERT ST N, SAINT PAUL, MN 55104
(651) 282-0460
(651) 644-1126
Mailing address
806 ALBERT ST N, SAINT PAUL, MN 55104-1303
(651) 282-0460
(651) 644-1126
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
803854-3-CDT
MN
Other
Enumeration date
05/10/2010
Last updated
05/10/2010
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