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MICAH HOUSE
NPI 1093190258
Substance Abuse Rehabilitation Facility in Minneapolis, MN

Active since July 29, 2015
3047 5TH AVE S, MINNEAPOLIS, MN 55408(651) 827-0484(612) 827-0485 Get Directions Write a Review

NPPES record last updated: July 29, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Micah House NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICAH HOUSE (NPI 1093190258) is a healthcare organization registered as a substance abuse rehabilitation facility in Minneapolis, Minnesota and active in the NPI registry since July 2015. The organization lists Anthony Scott Holmquist-burks, Clinical Supervisor, as its authorized official.

NPPES Registry Identity

NPI1093190258
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameMICAH HOUSE
Location Address3047 5TH AVE SMinneapolis, MN 55408-2415
Mailing Address3047 5th Ave SMinneapolis, MN 55408-2415 · (651) 827-0484 · Fax (612) 827-0485
Phone(651) 827-0484
Fax(612) 827-0485
Organization SubpartNo
Authorized OfficialAnthony Scott Holmquist-burksClinical Supervisor · (612) 827-0484
Enumeration DateJuly 29, 2015
✔ NPI 1093190258 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
License✔ Licensed in MN · 303472
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
3047 5TH AVE S, Minneapolis, MN 55408
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Other Identifiers 1

Medicaid303472MN

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICTORY THROUGH FAITH RECOVERY SERVICES
Substance Abuse Rehabilitation Facility
3047 5TH AVE S
MINNEAPOLIS, MN 55408
Hennepin County (612) 827-0484

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Micah House's NPI number?

The NPI number for Micah House is 1093190258. It was assigned to this organization in the NPPES registry on July 29, 2015.

Where is Micah House located?

Micah House is located at 3047 5th Ave S, Minneapolis, MN 55408. The listed phone number is (651) 827-0484.

What is Micah House's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

When was this NPI record last updated?

The NPPES record for Micah House was last updated on July 29, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.