Provider Demographics
NPI:1114471117
Name:ALEXANDRIA INDUSTRIES FAMILY HEALTH & WELLNESS CLINIC
Entity Type:Organization
Organization Name:ALEXANDRIA INDUSTRIES FAMILY HEALTH & WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLIAMS-CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-832-9467
Mailing Address - Street 1:690 VOYAGER DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-5295
Mailing Address - Country:US
Mailing Address - Phone:320-335-2833
Mailing Address - Fax:320-335-2469
Practice Address - Street 1:690 VOYAGER DR
Practice Address - Street 2:SUITE 8
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5295
Practice Address - Country:US
Practice Address - Phone:320-335-2833
Practice Address - Fax:320-335-2469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACHIEVE WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-08
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care