Healthcare Provider Details

I. General information

NPI: 1144329632
Provider Name (Legal Business Name): VINLAND NATIONAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 IHDUHAPI RD
LORETTO MN
55357-0308
US

IV. Provider business mailing address

PO BOX 308
LORETTO MN
55357-0308
US

V. Phone/Fax

Practice location:
  • Phone: 763-479-3555
  • Fax: 763-479-2605
Mailing address:
  • Phone: 763-479-3555
  • Fax: 763-479-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10613151MHC
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number802601-3-CDT
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1039413-1-CDT
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number8026015CDT
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number10394132CDT
License Number StateMN

VIII. Authorized Official

Name: RENEE OLSON
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 763-479-4518