Provider Demographics
NPI:1861727810
Name:CANVAS HEALTH, INC.
Entity type:Organization
Organization Name:CANVAS HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:EASTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPA, LMFT
Authorized Official - Phone:651-777-5222
Mailing Address - Street 1:375 ORLEANS ST E
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5830
Mailing Address - Country:US
Mailing Address - Phone:651-430-2720
Mailing Address - Fax:651-351-3155
Practice Address - Street 1:7565 4TH AVE
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1068
Practice Address - Country:US
Practice Address - Phone:651-430-2720
Practice Address - Fax:651-351-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty