Provider Demographics
NPI:1053576751
Name:DAKOTA COUNTY JAIL TREATMENT PROGRAM
Entity type:Organization
Organization Name:DAKOTA COUNTY JAIL TREATMENT PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-554-6000
Mailing Address - Street 1:1580 HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2343
Mailing Address - Country:US
Mailing Address - Phone:651-438-4818
Mailing Address - Fax:651-438-4808
Practice Address - Street 1:1 MENDOTA RD W
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-4764
Practice Address - Country:US
Practice Address - Phone:651-554-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1049367261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder