Healthcare Provider Details

I. General information

NPI: 1609975713
Provider Name (Legal Business Name): FOUR WINDS CENTER FOR WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28141 LAKELAWN DRIVE
LINDSTROM MN
55045
US

IV. Provider business mailing address

28141 LAKELAWN DRIVE
LINDSTROM MN
55045
US

V. Phone/Fax

Practice location:
  • Phone: 651-257-9566
  • Fax:
Mailing address:
  • Phone: 651-257-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALAN LOUIS CIROCCO
Title or Position: COOWNER OPERATOR
Credential: MSW LICSW
Phone: 218-444-2055