1548436090 NPI number — VOLUNTEERS OF AMERICA MN/WI

Table of content: (NPI 1548436090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548436090 NPI number — VOLUNTEERS OF AMERICA MN/WI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VOLUNTEERS OF AMERICA MN/WI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VOLUNTEERS OF AMERICA OF MINNESOTA MENTAL HEALTH CLINICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548436090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7625 METRO BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55439-3057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-945-4092
Provider Business Mailing Address Fax Number:
888-965-5130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9220 BASS LAKE RD STE 255
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HOPE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55428-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-945-4052
Provider Business Practice Location Address Fax Number:
888-965-5130
Provider Enumeration Date:
05/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FJELSTUL
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
763-225-4052

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  8105041MHC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 098222900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".