Provider Demographics
NPI:1447989744
Name:ASPEN HOUSE
Entity type:Organization
Organization Name:ASPEN HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE CONTROLLER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VARBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, EDD
Authorized Official - Phone:763-551-8640
Mailing Address - Street 1:505 HIGHWAY 169 N STE 500
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2031 VICTORIA RD S
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-4163
Practice Address - Country:US
Practice Address - Phone:763-551-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXUS FAMILY HEALING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness