Avalon Programs, LLC
Organization Active NPI Substance Abuse Rehabilitation Facility · Minnetonka, MN
NPI 1922448620 · NPPES record last updated Feb 21, 2025
Key facts
- NPI
- 1922448620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- License
- 1065949 (MN)
- Legal business name
- AVALON PROGRAMS, LLC
- Practice address
- 11900 Wayzata Blvd
Suite 100
Minnetonka, MN 55305-2031 - Phone
- (612) 454-2012
- NPI assigned
- Jun 27, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- AVALON PROGRAMS LLC
Authorized official
- Name
- Lewis P Zeidner, PHD
- Title
- Ceo
- Phone
- (763) 245-8278
Corporate family (same tax ID) 11
Practitioners 2
-
Ernest William Lampe, M.D.
-
Matthew Jon Thorson, LADC
National Provider Directory
- Tax ID family
- Avalon Meridian Behavioral Health
- Part of
- Avalon Meridian Behavioral Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | 1065949 | MN | |
| Substance Abuse Rehabilitation Facility | 324500000X | 1065949 | MN | Yes |
Addresses
Primary practice location
11900 Wayzata Blvd
Suite 100
Minnetonka, MN 55305-2031
Mailing address
550 Main St Ste 190
Saint Paul, MN 55112-3271
Phone (612) 454-2046
Other names
- EOSIS AT MINNETONKA
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.