Vinland National Center
Organization Active NPI Substance Abuse Rehabilitation Facility · Loretto, MN
NPI 1144329632 · NPPES record last updated Sep 15, 2025
Key facts
- NPI
- 1144329632
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- License
- 8026015CDT (MN)
- Legal business name
- VINLAND NATIONAL CENTER
- Practice address
- 3675 Ihduhapi Rd
Loretto, MN 55357-0308 - Phone
- (763) 479-3555
- Fax
- (763) 479-2605
- NPI assigned
- Sep 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Renee Olson
- Title
- Executive Administrator
- Phone
- (763) 479-4518
Practitioners 12
-
Willie Bernard Garrett, MS-LP, ED.D.
-
Angie Hyde, LPCC
-
Peggy Martin, LPCC
-
John Ernest Simon, M.D.
-
Mark Thomas Collins, MA, LPCC, LADC
-
Gabriel Storm Becker-Finn, MA, LPCC
-
Ricki Gene Krueger, MA, LPC, LADC
-
Melissa Ann Petoletti, MS, LPCC, LADC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2062859 | Vinland National Center | Certificate of waiver | Jul 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130304000612 | MN | Part B Supplier - Clinic/Group Practice | 1557516184 |
Receives reassigned benefits from 8 practitioners Practice locations: Minneapolis, MN; Loretto, MN |
National Provider Directory
Locations
675 Stinson Blvd
Ste 200
Minneapolis, MN 55413
Phone (763) 479-3555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 10613151MHC | MN | |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Substance Abuse Rehabilitation Facility | 324500000X | 802601-3-CDT | MN | |
| Substance Abuse Rehabilitation Facility | 324500000X | 1039413-1-CDT | MN | |
| Substance Abuse Rehabilitation Facility | 324500000X | 8026015CDT | MN | Yes |
| Substance Abuse Rehabilitation Facility | 324500000X | 10394132CDT | MN |
Addresses
Primary practice location
3675 Ihduhapi Rd
Loretto, MN 55357-0308
Mailing address
PO Box 308
Loretto, MN 55357-0308
Phone (763) 479-3555
Other practice location 1
675 Stinson Blvd Ste 200
Minneapolis, MN 55413-2762
Phone (763) 479-3555
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 098055200 | Medicaid | MN |
Other providers in Loretto, MN
- Richard C Axel, DDS, PA
- Jerry Jack Robb
- Bee S. Soung
- Drauzong Soung
- Mai Yer Soung
- Heather Joy Volker
- Rachel Elizabeth White Robinson
- Laurence Edward Winter
All providers in Loretto, MN · Substance Abuse Rehabilitation Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.