Provider Demographics
NPI:1912223033
Name:HIAWATHA VALLEY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:HIAWATHA VALLEY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-454-4341
Mailing Address - Street 1:420 E SARNIA ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6414
Mailing Address - Country:US
Mailing Address - Phone:507-454-4341
Mailing Address - Fax:507-453-6267
Practice Address - Street 1:221 S KINGSTON ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MN
Practice Address - Zip Code:55921-1317
Practice Address - Country:US
Practice Address - Phone:507-725-2022
Practice Address - Fax:507-725-3474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIAWATHA VALLEY MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN25475540Medicaid
WI100007314Medicaid
MN25475540Medicaid