Valhalla Place Brainerd LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

VALHALLA PLACE BRAINERD LLC

Practice address

2215 S 6TH St
Brainerd, MN 56401-5549

Phone

(763) 276-4856

NPI assigned

Jul 29, 2011

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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

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

CLIA laboratory certificates

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": "1311897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1881972503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564015549",
            "telephone_number": "763-276-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564015549",
            "telephone_number": "763-276-4856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALHALLA PLACE BRAINERD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-29",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "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": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Michael Trebil, BC-HIS
• Becky Twamley
• Audrey Jean Twit, PHARMD
• Nicolle Marie Uban, PHD, APRN, CNM
• Jenna Bergin Ude, D.D.S.
• Jon Richard Van Der Hagen, MD
• Alexa Vanalst
• Dannia Lor Vang, PHARMD
• John Vanmoer
• Jayme Nicole Vanrisseghem, PHARMD

• Methadone Clinic in Brainerd, MN
• Providers in Brainerd, 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 27, 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.