Provider Demographics
NPI:1780850446
Name:VOLUNTEERS OF AMERICA OF MINNESOTA
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA OF MINNESOTA
Other - Org Name:WOMEN'S RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CORRECTIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-721-6327
Mailing Address - Street 1:2825 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1929
Mailing Address - Country:US
Mailing Address - Phone:612-721-6327
Mailing Address - Fax:612-721-1506
Practice Address - Street 1:5100 HODGSON RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-1229
Practice Address - Country:US
Practice Address - Phone:651-484-7840
Practice Address - Fax:651-484-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10100892CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility