Provider Demographics
NPI:1659956316
Name:VOLUNTEERS OF AMERICA MINNESOTA
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE HOLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-945-4007
Mailing Address - Street 1:7625 METRO BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3053
Mailing Address - Country:US
Mailing Address - Phone:952-945-4000
Mailing Address - Fax:888-526-2871
Practice Address - Street 1:3333 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2615
Practice Address - Country:US
Practice Address - Phone:952-945-4175
Practice Address - Fax:888-972-5328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOLUNTEERS OF AMERICA MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA976615800Medicaid