Basic Information
| Provider Information | |||||||||
| NPI: | 1659694172 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEMIDJI AREA PROGRAM FOR RECOVERY INC. STEPS TO FREEDOM PROGRAM | ||||||||
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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: | 626 MINNESOTA AVE NW | ||||||||
| Address2: | |||||||||
| City: | BEMIDJI | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566013037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184445155 | ||||||||
| FaxNumber: | 2183333921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | BUSCHER | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2184445155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 1056317-1-CDT | MN | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7J00BE | 01 | MN | BLUECROSS BLUE SHIELD | OTHER | 10006646 | 01 | MN | PRIMEWEST HEALTH | OTHER |