National Provider Identifier Database

EDGE HEALTH CARE AND MENTAL HEALTH SERVICES
Substance Abuse Treatment, Children

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included.


Contact Information

EDGE HEALTH CARE AND MENTAL HEALTH SERVICES
157 GRASS LAKE PL APT 309
SHOREVIEW, MN55126-2063
Phone: 763-498-4448
Fax:
Website:
Specialty Taxonomy Code
* Substance Abuse Treatment, Children 3245S0500X
Assisted Living, Mental Illness 3104A0625X
Community/Behavioral Health 251S00000X
Gerontology 363LG0600X
Mental Health (Including Community Mental Health Center) 261QM0801X
Psychiatric/Mental Health 363LP0808X

* Indicates primary specialty

NPI Profile & details for EDGE HEALTH CARE AND MENTAL HEALTH SERVICES

NPI Number 1467201301
Legal business name
LBN
EDGE HEALTH CARE AND MENTAL HEALTH SERVICES
Authorized official EKAN EKONG - (PMHNP-BC)
Entity Organization
Organization subpart No
Enumeration date 05/14/2024
Last updated 10/21/2024 - More than a year ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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