Provider Demographics
NPI:1609975713
Name:FOUR WINDS CENTER FOR WELLNESS INC
Entity Type:Organization
Organization Name:FOUR WINDS CENTER FOR WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CIROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:218-444-2055
Mailing Address - Street 1:28141 LAKELAWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045
Mailing Address - Country:US
Mailing Address - Phone:651-257-9566
Mailing Address - Fax:
Practice Address - Street 1:28141 LAKELAWN DRIVE
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045
Practice Address - Country:US
Practice Address - Phone:651-257-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty