SAGE PRAIRIE NPI 1720406168

NPI Information

NPI: 1720406168
Provider Name: SAGE PRAIRIE
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 24D2076752

Address:
13005 COUNTY ROAD 5
BURNSVILLE, MN
ZIP 55337
Phone: (952) 451-8160
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SAGE PRAIRIE is a rehabilitation and substance use disorder clinic center in Burnsville, MN. SAGE PRAIRIE NPI is 1720406168. The provider is registered as an organization entity type.

The provider's business location address is:

13005 COUNTY ROAD 5
BURNSVILLE, MN
ZIP 55337
Phone: (952) 451-8160
Fax: (612) 437-4913

The provider's authorized official is Marcus Blue .
The authorized official title is Operations Officer and has the following contact phone number (952) 451-8160.

The CLIA number assigned to this NPI record is 24D2076752 - other - chemical dependency with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/2/2014 and was last updated on 9/25/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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