Organization · Type 2 NPI

Minnesota Teen Challenge, Inc.

Substance Abuse Rehabilitation Facility · Rochester, MN

NPI number 1285057539 Active

Practice location

1530 Assisi Dr NW
Rochester, MN 55901

Call (507) 288-3733 Map

Fax (855) 288-8560

Mailing address

1619 Portland Ave S
Minneapolis, MN 55404

Other practice locations

40 16th St SE Ste E, Rochester, MN 55904-7987 · (612) 373-3366

Specialties and licenses

Taxonomy	Code	License
Addiction (Substance Use Disorder) Counselor	101YA0400X	None listed
Exclusive Provider Organization	302F00000X	None listed
Substance Abuse Rehabilitation Facility Primary	324500000X	None listed

Substance Abuse Rehabilitation Facility: A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

8 other providers at this address

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NPI record

NPI: 1285057539
Entity type: Organization (Type 2)
Issued: Jan 22, 2014
Last updated: Mar 14, 2022
Status: Active

Other names

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Minnesota Adult & Teen Challenge · doing business as
Minnesota Adult & Teen Challenge · doing business as

Authorized official

Mr. Michael William Mahoney, LADC, NCAC1
Treatment Director
(507) 218-3450

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1285057539

Minnesota Teen Challenge, Inc.'s National Provider Identifier is 1285057539, issued on Jan 22, 2014. The primary taxonomy on file is Substance Abuse Rehabilitation Facility (324500000X), and the practice location is in Rochester, MN. The record was last updated on Mar 14, 2022.