Provider Demographics
NPI:1508835133
Name:ALLUMA, INC.
Entity Type:Organization
Organization Name:ALLUMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REITMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:218-281-3940
Mailing Address - Street 1:603 BRUCE STREET
Mailing Address - Street 2:PO BOX 603
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-0603
Mailing Address - Country:US
Mailing Address - Phone:218-281-3940
Mailing Address - Fax:218-281-6261
Practice Address - Street 1:603 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716
Practice Address - Country:US
Practice Address - Phone:218-281-3940
Practice Address - Fax:218-281-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8017741MHC261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN054855300Medicaid
93272OtherPREFERRED ONE
CC6573OtherRAILROAD MEDICARE
MN116586OtherUCARE MINNESOTA
1520165OtherUBH MEDICA
MN63592NOOtherBCBS BHSI
31167OtherHEALTH PARTNERS
=========OtherTRI CARE
MN054855300Medicaid
MNC07968Medicare PIN