Provider Demographics
NPI:1366618852
Name:NORTHLAND DEPENDENCY SERVICES, LLC
Entity type:Organization
Organization Name:NORTHLAND DEPENDENCY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RSAP
Authorized Official - Phone:816-781-8999
Mailing Address - Street 1:26 S GALLATIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2302
Mailing Address - Country:US
Mailing Address - Phone:816-781-8999
Mailing Address - Fax:816-792-2883
Practice Address - Street 1:26 S GALLATIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2302
Practice Address - Country:US
Practice Address - Phone:816-781-8999
Practice Address - Fax:816-792-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1264-8522261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder