Provider Demographics
NPI:1275679060
Name:VAIL PLACE
Entity Type:Organization
Organization Name:VAIL PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE AND CONTRACT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:COCHRAN
Authorized Official - Last Name:ZUZEK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:952-945-4250
Mailing Address - Street 1:23 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7629
Mailing Address - Country:US
Mailing Address - Phone:952-938-9622
Mailing Address - Fax:952-938-7934
Practice Address - Street 1:23 9TH AVE S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7629
Practice Address - Country:US
Practice Address - Phone:952-938-9622
Practice Address - Fax:952-938-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN956400400Medicaid