Provider Demographics
NPI:1871627257
Name:AVALON PROGRAMS LLC
Entity type:Organization
Organization Name:AVALON PROGRAMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-916-4876
Mailing Address - Street 1:550 MAIN STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-326-7600
Mailing Address - Fax:612-631-3231
Practice Address - Street 1:34079 LAKETOWN ROAD
Practice Address - Street 2:SUITE #7
Practice Address - City:STURGEON LAKE
Practice Address - State:MN
Practice Address - Zip Code:55783
Practice Address - Country:US
Practice Address - Phone:218-372-8000
Practice Address - Fax:218-372-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1034226101YA0400X
MN1054088-1-CDT101YA0400X
MN1034226-2-CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty