| Avalon - Pine City | |
|
655 3rd Ave Sw Pine City MN 55063-1443 | |
| (612) 326-7555 | |
| Not Available |
| Full Name | Avalon - Pine City |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 655 3rd Ave Sw, Pine City, Minnesota |
| Authorized Official Name and Position | Valerie Bundy (CONTROLLER) |
| Authorized Official Contact | 6123267555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avalon - Pine City 550 Main St New Brighton MN 55112-3271 Ph: (612) 326-7555 | Avalon - Pine City 655 3rd Ave Sw Pine City MN 55063-1443 Ph: (612) 326-7555 |
| NPI Number | 1316151335 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316151335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1034226 (Minnesota) | Primary |
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