Provider Demographics
NPI:1922448620
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 190
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3271
Mailing Address - Country:US
Mailing Address - Phone:612-454-2046
Mailing Address - Fax:952-679-5471
Practice Address - Street 1:11900 WAYZATA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2031
Practice Address - Country:US
Practice Address - Phone:612-454-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVALON PROGRAMS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-27
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1065949101YA0400X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty