Provider Demographics
NPI:1275592081
Name:VOLUNTEERS OF AMERICA OF MINNESOTA
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA OF MINNESOTA
Other - Org Name:CHILDREN'S RESIDENTIAL TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILBUR
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:763-546-3242
Mailing Address - Street 1:5908 GOLDEN VALLEY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4414
Mailing Address - Country:US
Mailing Address - Phone:763-546-3242
Mailing Address - Fax:763-546-2774
Practice Address - Street 1:143 E 19TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3809
Practice Address - Country:US
Practice Address - Phone:612-870-4300
Practice Address - Fax:612-870-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1004840-2-CRF322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
5053680OtherUBH PROVIDER NUMBER
6C06CHOtherBC/BS MN PROVIDER NUMBER