Provider Demographics
NPI:1538293915
Name:AVALON PROGRAMS LLC
Entity Type:Organization
Organization Name:AVALON PROGRAMS LLC
Other - Org Name:AVALON - COTTAGE GROVE
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 STREET
Mailing Address - Street 2:SUITE 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 1:7501 80TH STREET SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016
Practice Address - Country:US
Practice Address - Phone:651-458-3757
Practice Address - Fax:651-458-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MN8009954CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty