Valhalla Place, LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

1063405 Issued in MN

Legal business name

VALHALLA PLACE, LLC

Practice address

2807 Brookdale Dr
Brooklyn Park, MN 55444-1844

Phone

(651) 925-8200

NPI assigned

Oct 18, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jay Higham

Title

Ceo

Phone

(214) 365-6112

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Valhalla Place, LLC

  • Community/Behavioral Health Agency
  • Woodbury, MN
  • NPI 1881856664

  O20200210000064

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Valhalla Place LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Valhalla Place, LLC

  • Community/Behavioral Health Agency
  • Woodbury, MN
  • NPI 1881856664
  NPD tax ID

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• B Tek, LLC

  • Clinical Medical Laboratory
  • Woodbury, MN
  • NPI 1609256122

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lilian Kigonya, M.D., M.P.H.

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1932375110
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1801149505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6043 HUDSON RD",
            "address_2": "220",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251018",
            "telephone_number": "651-925-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 BROOKDALE DR",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554441844",
            "telephone_number": "651-925-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALHALLA PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A",
        "authorized_official_last_name": "HIGHAM",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-365-6112"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15731",
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MN",
            "license": "1063405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260163778",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Michelle Vang, B.A
• Nkaujci Vang, DCM, LAC.

• Methadone Clinic in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Methadone Clinic in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.