Basic Information
| Provider Information | |||||||||
| NPI: | 1265177398 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEMIDJI AREA PROGRAM FOR RECOVERY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 4TH ST NW STE 300 | ||||||||
| Address2: | |||||||||
| City: | BEMIDJI | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566013196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184445155 | ||||||||
| FaxNumber: | 2183333921 | ||||||||
| Practice Location | |||||||||
| Address1: | 16730 US HWY 2 | ||||||||
| Address2: | |||||||||
| City: | BAGLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184445155 | ||||||||
| FaxNumber: | 2183333921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2022 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | BUSCHER | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2184445155 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEMIDJI AREA PROGRAM FOR RECOVERY, INC. | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 1411674742 | 05 | MN | MEDICAID | 1363897080 | 01 | MN | BLUE PLUS | OTHER | 1410984460 | 01 | MN | BLUE CROSS BLUE SHIELD MINNESOTA | OTHER | 1411901281 | 01 | MN | PRIMEWEST | OTHER | 1363573805 | 01 | UCARE | OTHER |