Basic Information
| Provider Information | |||||||||
| NPI: | 1952766651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVALON PROGRAMS LLC | ||||||||
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| OtherOrganizationName: | NEW BEGINNINGS MINNESOTA AT ST. ANTHONY PARK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 MAIN ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551123274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123267600 | ||||||||
| FaxNumber: | 6124542178 | ||||||||
| Practice Location | |||||||||
| Address1: | 2446 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551140001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516470095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2015 | ||||||||
| LastUpdateDate: | 03/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | ASPER | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR CONTRACT. CRED, AND PAYER | ||||||||
| AuthorizedOfficialTelephone: | 6124542046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 1047590 | MN | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.