Provider Demographics
NPI:1154455533
Name:AVALON PROGRAMS, LLC
Entity Type:Organization
Organization Name:AVALON PROGRAMS, LLC
Other - Org Name:AVALON - MIDWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-REVENUE CYCLE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-326-7566
Mailing Address - Street 1:550 MAIN ST
Mailing Address - Street 2:STE 230
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-326-7600
Mailing Address - Fax:651-631-3231
Practice Address - Street 1:1885 UNIVERSITY AVENUE WEST
Practice Address - Street 2:SUITE 151
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-647-0095
Practice Address - Fax:651-647-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1004393101YA0400X
MN1047590.1.CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty