Provider Demographics
NPI:1780186130
Name:ALLIANCE WELLNESS CLINIC INC.
Entity Type:Organization
Organization Name:ALLIANCE WELLNESS CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:952-693-0080
Mailing Address - Street 1:8040 OLD CEDAR AVE. S. STE. 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1211
Mailing Address - Country:US
Mailing Address - Phone:952-693-0080
Mailing Address - Fax:952-955-6567
Practice Address - Street 1:8040 OLD CEDAR AVE. S. STE. 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1211
Practice Address - Country:US
Practice Address - Phone:952-693-0080
Practice Address - Fax:952-955-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
MN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1780186130OtherNPI