Provider Demographics
NPI:1174799621
Name:VOLUNTEERS OF AMERICA OF MINNESOTA
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA OF MINNESOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-945-4000
Mailing Address - Street 1:22426 SAINT FRANCIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9670
Mailing Address - Country:US
Mailing Address - Phone:763-753-7310
Mailing Address - Fax:763-753-6529
Practice Address - Street 1:5905 GOLDEN VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4463
Practice Address - Country:US
Practice Address - Phone:763-225-4052
Practice Address - Fax:888-965-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1163103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN694319500Medicaid