Provider Demographics
NPI:1356342604
Name:PSI PRIDE INSTITUTE INC
Entity type:Organization
Organization Name:PSI PRIDE INSTITUTE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SRVP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:14400 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-2031
Mailing Address - Country:US
Mailing Address - Phone:952-934-7554
Mailing Address - Fax:952-934-8764
Practice Address - Street 1:14400 MARTIN DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-2031
Practice Address - Country:US
Practice Address - Phone:952-934-7554
Practice Address - Fax:952-934-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1030116-1-CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN101123OtherHEALTH PARTNERS INS
MN1043387OtherPREFERRED ONE INS
MN630114200Medicaid
MN300658OtherUCARE INSURANCE
MN9L22PIOtherBCBS INSURANCE
MN320670OtherVALUE OPTIONS MCO