WAYSIDE HOUSE, INC. (NPI# 1649756040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649756040 |
| Entity Type | Organization |
| Organization Name | WAYSIDE HOUSE, INC. |
| Other Organization Name | WAYSIDE RECOVERY CENTER |
| Practice Address |
1349 Jersey Ave S St. Louis Park MN 55426 |
| Mailing Address |
3705 Park Center Blvd St. Louis Park MN 55416 |
| Practice Telephone | 9525429322 |
| Practice Fax Number | 9525420031 |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |
| Authorized Official Name | KARINA FORREST-PERKINS (CEO) |
| Authorized Official Telephone | 6512425542 |
| Authorized Official Credential | MHR LADC |
| Is Organization Subpart | Y |
| Parent Organization Name | WAYSIDE HOUSE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
1092849 | MN | Ambulatory Health Care Facilities |
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1092849 | MN | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Wayside Recovery Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780830224 | Wayside House, Inc. | Case Management | 378 Ne 6th Ave, Delray Beach, FL 33483-5517 | 2008-08-15 |
| Street Address |
1349 JERSEY AVE S |
| City | ST. LOUIS PARK |
| State | MN |
| Zip Code | 55426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821657545 | Big Brain Concussion Recovery & Chiropractic Pa | Chiropractor | 3313 Republic Ave., St. Louis Park, MN 55426 | 2019-06-06 |
| 1912485095 | Daniel Raies | Optometrist | 8900 Minnesota 7, St Louis Park, MN 55426 | 2018-08-01 |
| 1104302884 | Superior Caregivers, LLC | In Home Supportive Care | 1319 Lancaster Ave., St. Louis Park, MN 55426 | 2018-07-16 |
| 1396234266 | Caitlin Kwiatkowski | Behavior Technician | 7010 Mn-7, St.louis Park, MN 55426 | 2018-05-07 |
| 1497244313 | Kelly Ann Clancey | Behavior Technician | 7010 Highway 2, Saint Louis Park, MN 55426 | 2018-05-07 |
| 1770072696 | Ashleigh Hakala | Behavior Technician | 7010 Highway 7 St. Louis Park Mn 55426, St. Louis Park, MN 55426 | 2018-05-07 |
| 1689181521 | Glenda Miles | Registered Nurse | 7316 Cedar Lake Road, Apt 8, St Louis Park, MN 55426 | 2017-12-31 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1447775549 | Belinda Sue Bliss | Marriage & Family Therapist | 3301 Decatur Lane, Saint Louis Park, MN 55426 | 2017-08-09 |
| 1861916017 | Brittany Joy Willis | Occupational Therapist | 3931 Louisana Ave, St Louis Park, MN 55426 | 2017-07-31 |
| Find all providers in zip 55426 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | 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. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948584 | Sober Living Connection | Substance Abuse Rehabilitation Facility | 11115 Minnetonka Blvd, Hopkins, MN 55305 | 2020-09-30 |
| 1730791393 | Crecer Services | Substance Abuse Rehabilitation Facility | 220 Robert St S Ste 103, Saint Paul, MN 55107-1626 | 2020-08-17 |
| 1801405584 | Bridge Recovery LLC | Substance Abuse Rehabilitation Facility | 1485 10th Avenue Ne, Sauk Rapids, MN 56379-9838 | 2020-07-28 |
| 1710505821 | Rrecovery Services | Substance Abuse Rehabilitation Facility | 867 Pierce Butler Rte, Saint Paul, MN 55104-1522 | 2020-07-06 |
| 1912520966 | Avenues, LLC | Substance Abuse Rehabilitation Facility | 1990 Suburban Ave Ste 2000, Saint Paul, MN 55119-7001 | 2020-05-26 |
| 1962022939 | Valley View Recovery Center Inc. | Substance Abuse Rehabilitation Facility | 31591 64th Ave, Cannon Falls, MN 55009-4296 | 2020-04-20 |
| 1801420039 | Recovery Center LLC | Substance Abuse Rehabilitation Facility | 109 W James St, Paynesville, MN 56362-1216 | 2020-02-26 |
| 1336772425 | Northern Minnesota Addiction Wellness Center | Substance Abuse Rehabilitation Facility | 4851 Stacy Ann Dr Nw, Bemidji, MN 56601 | 2020-02-17 |
| 1386277622 | Community of Recovering People | Substance Abuse Rehabilitation Facility | 1221 Wayzata Blvd E, Wayzata, MN 55391-1942 | 2020-02-14 |
| 1992366645 | One Touch of Christ Evangelistic Ministries | Substance Abuse Rehabilitation Facility | 5701 Shingle Creek Pkwy Ste 650, Brooklyn Center, MN 55430-2492 | 2019-06-24 |
| Find all providers with the same taxonomy | ||||
| City | ST. LOUIS PARK |
| Zip Code | 55426 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.