Organization · NPI-2

Avalon Programs, LLC

Counselor, Addiction (Substance Use Disorder) · Minneapolis, MN

NPI number1104950591
StatusActive
Last updated in NPPESDec 10, 2008

Details

NPI
1104950591
Entity type
Organization (NPI-2)
Legal business name
Avalon Programs, LLC
Organization subpart
No
Enumeration date
Mar 15, 2007
Last updated
Dec 10, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YA0400X Counselor, Addiction (Substance Use Disorder)1016848MNYes
324500000X Substance Abuse Rehabilitation Facility1016848-4-CDTMN

Other names

  • Avalon - Prospect Park (Doing Business As)

Practice location

2800 University Ave Se
Suite 202
Minneapolis, MN 55414

Phone 612-638-2282 · Fax 612-326-7642

Mailing address

550 Main St
Ste 230
New Brighton, MN 55112

Phone 612-326-7600 · Fax 651-631-3231

Authorized official

Paul Lindeman
Director - Revenue Cycle Mgmt
6123267566

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