Provider Demographics
NPI:1952766651
Name:AVALON PROGRAMS, LLC
Entity type:Organization
Organization Name:AVALON PROGRAMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-245-8278
Mailing Address - Street 1:550 MAIN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3274
Mailing Address - Country:US
Mailing Address - Phone:612-326-7600
Mailing Address - Fax:612-454-2178
Practice Address - Street 1:550 MAIN STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:651-647-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1047590324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility