Provider Demographics
NPI:1003969148
Name:AVALON CENTER
Entity Type:Organization
Organization Name:AVALON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW, CADC, MA
Authorized Official - Phone:641-422-0070
Mailing Address - Street 1:22 N GEORGIA AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3435
Mailing Address - Country:US
Mailing Address - Phone:641-422-0070
Mailing Address - Fax:641-422-0060
Practice Address - Street 1:22 N GEORGIA AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3435
Practice Address - Country:US
Practice Address - Phone:641-422-0070
Practice Address - Fax:641-422-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1012138Medicaid