THE WAYSIDE HOUSE, INC. (NPI# 1932413887) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932413887 |
| Entity Type | Organization |
| Organization Name | THE WAYSIDE HOUSE, INC. |
| Other Organization Name | INCARNATION FAMILY CONNECTIONS |
| Practice Address |
2120 Clinton Ave S Minneapolis MN 55404 |
| Mailing Address |
3705 Park Center Blvd. St. Louis Park MN 55416 |
| Practice Telephone | 6128710099 |
| Practice Fax Number | 6128710929 |
| Mailing Telephone | 9529265626 |
| Mailing Fax Number | 9529269713 |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2010-08-03 |
| Authorized Official Name | MS. ELLIE SKELTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9524057636 |
| Authorized Official Credential | MA, CPRP |
| Is Organization Subpart | Y |
| Parent Organization Name | THE WAYSIDE HOUSE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1055132-1-CDT | MN | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Incarnation Family Connections | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861884579 | The Wayside House, Inc. | Community/Behavioral Health | 2356 University Ave W, Suite 210, Saint Paul, MN 55114-1853 | 2015-03-04 |
| Street Address |
2120 CLINTON AVE S |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568062461 | Andrew Moe | Counselor | 2118 Blaisdell Ave S., Minneapolis, MN 55404 | 2020-10-29 |
| 1194368191 | Luz Angelica Fehn Salinas | Psychologist | 1315 E24th St, Minneapolis, MN 55404 | 2019-10-22 |
| 1760969125 | Bethany Karen Kenny | Registered Nurse | 910 E 26th St Ste 200, Minneapolis, MN 55404 | 2018-07-27 |
| 1225535701 | Karissa Dougherty | Nurse Practitioner | 2200 E Franklin Ave # 199, Minneapolis, MN 55404 | 2018-04-10 |
| 1891299491 | Guidance Home Health Care LLC | Home Health | 2529 Nicollet Avenue 202b, Minneapolis, MN 55404 | 2018-03-20 |
| 1770085490 | Bright Future Counseling Service, LLC | Counselor | 912 E. 24th St., Suite B215, Minneapolis, MN 55404 | 2018-03-08 |
| 1346754298 | Juba Pharmacy Inc | Pharmacy | 1926 Chicago Ave S, Minneapolis, MN 55404 | 2017-11-29 |
| 1629597323 | Kira Larson Fieldstrom | Social Worker | 2400 Blaisdell Ave., Minneapolis, MN 55404 | 2017-09-13 |
| 1770008930 | Nicole Lynn Sparks | Social Worker | 2445 Park Avenue, Minneapolis, MN 55404 | 2017-08-09 |
| 1639612765 | Cosmo Home Healthcare Services, L.L.C. | Home Health | 2219 Oakland Ave S, Suite 104, Minneapolis, MN 55404 | 2016-11-21 |
| Find all providers in zip 55404 | ||||
| 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 |
|---|---|---|---|---|
| 1366913287 | Guided Pathway | Substance Abuse Rehabilitation Facility | 2119 Elliot Ave, Minneapolis, MN 55404-2971 | 2018-12-17 |
| 1407322217 | Mabs Recovery Center LLC | Substance Abuse Rehabilitation Facility | 5941 Washburn Ave S, Minneapolis, MN 55410-2848 | 2018-10-18 |
| 1063883411 | Life Refine Company, Inc. | Substance Abuse Rehabilitation Facility | 6901 78th Ave N Ste 106, Minneapolis, MN 55445-2720 | 2015-10-12 |
| 1336432087 | South East Homes Inc | Substance Abuse Rehabilitation Facility | 2732 Bloomington Ave, Minneapolis, MN 55407-1146 | 2011-05-26 |
| 1023314440 | Centre for African Immigrants Recovering From Drug and Alcohol Addicti | Substance Abuse Rehabilitation Facility | 5201 Bryant Ave N, Minneapolis, MN 55430-3588 | 2011-02-02 |
| 1982831533 | Specialized Treatment Services, Inc. | Substance Abuse Rehabilitation Facility | 1132 Central Ave. Ne, Minneapolis, MN 55413-1512 | 2009-06-22 |
| 1548433840 | Victory Through Faith Recovery Services | Substance Abuse Rehabilitation Facility | 3047 5th Ave S, Minneapolis, MN 55408-2415 | 2008-04-08 |
| 1629296900 | Turning Point Incorporated | Substance Abuse Rehabilitation Facility | 1500 Golden Valley Road, Minneapolis, MN 55411 | 2007-04-23 |
| 1104950591 | Avalon Programs, LLC | Substance Abuse Rehabilitation Facility | 2800 University Ave Se, Suite 202, Minneapolis, MN 55414 | 2007-03-15 |
| 1558495010 | Alliance Clinic, LLC | Substance Abuse Rehabilitation Facility | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2007-03-15 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55404 |
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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.