| Vinland National Center | |
|
3675 Ihduhapi Rd Loretto MN 55357-0308 | |
| (763) 479-3555 | |
| (763) 479-2605 |
| Full Name | Vinland National Center |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 3675 Ihduhapi Rd, Loretto, Minnesota |
| Authorized Official Name and Position | Colleen Larson (OPERATIONS MANAGER) |
| Authorized Official Contact | 7634794514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vinland National Center P.o. Box 308 3675 Ihduhapi Road Loretto MN 55357-0308 Ph: (763) 479-3555 | Vinland National Center 3675 Ihduhapi Rd Loretto MN 55357-0308 Ph: (763) 479-3555 |
| NPI Number | 1144329632 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 10/13/2021 |
| Certification Date | 10/13/2021 |
| Medicare PECOS PAC ID | 1557516184 |
|---|---|
| Medicare Enrollment ID | O20130304000612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144329632 | NPI | - | NPPES |
| 098055200 | Medicaid | MN |
| Provider Name | Ralph E Mckinney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598800732 PECOS PAC ID: 2860430154 Enrollment ID: I20050418001122 |
| Provider Name | John E Simon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255374609 PECOS PAC ID: 7911972534 Enrollment ID: I20060725000378 |
| Provider Name | Thomas L Sawyer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871654343 PECOS PAC ID: 1850545427 Enrollment ID: I20130206000618 |
| Provider Name | Angelica M Stoltz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396272159 PECOS PAC ID: 4284903931 Enrollment ID: I20170712000438 |
| Provider Name | Willie B Garrett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780691592 PECOS PAC ID: 1052754249 Enrollment ID: I20240205001879 |
| Provider Name | Kaija M Muhich |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457901365 PECOS PAC ID: 3870944200 Enrollment ID: I20240214001130 |
| Provider Name | Peggy Martin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992109540 PECOS PAC ID: 0244681088 Enrollment ID: I20240219003155 |
| Provider Name | Angie M Hyde |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689440166 PECOS PAC ID: 3870944465 Enrollment ID: I20240314001226 |