Healthcare Provider Details

I. General information

NPI: 1104881911
Provider Name (Legal Business Name): ALLINA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1920
US

IV. Provider business mailing address

PO BOX 43 ROUTE 10860
MINNEAPOLIS MN
55440-0043
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-7957
  • Fax:
Mailing address:
  • Phone: 612-262-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number330760
License Number StateMN

VIII. Authorized Official

Name: JOSHUA SHEPHERD
Title or Position: PRESIDENT
Credential:
Phone: 763-688-7804