Basic Information
| Provider Information | |||||||||
| NPI: | 1407949167 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE HILLS YOUTH AND FAMILY SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CAMBIA HILLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4321 ALLENDALE AVENUE | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558031562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187287500 | ||||||||
| FaxNumber: | 2187287501 | ||||||||
| Practice Location | |||||||||
| Address1: | 4321 ALLENDALE AVENUE | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187287500 | ||||||||
| FaxNumber: | 2187287408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HEROLD | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 2186236425 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 040978200 | MN | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 322D00000X | 1036983-1-CRF | MN | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
ID Information
| ID | Type | State | Issuer | Description | 262L1WO | 01 | MN | BCBS OF MN | OTHER | 136305 | 01 | MN | UCARE MINNESOTA | OTHER | 8467273 | 01 | MN | UBH/MEDICA SELECT CARE | OTHER | 040978200 | 05 | MN | MEDICAID | 1042152 | 01 | MN | PREFERREDONE | OTHER |