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General NPI Number Information
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NPI Number | 1104881911
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Entity Type | Organization
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Legal Business Name | ALLINA HEALTH SYSTEM
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 701 DELLWOOD ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1920
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Country | US
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Telephone | 763-689-7957
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43 ROUTE 10860
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City | MINNEAPOLIS
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State | MN
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Zip | 55440-0043
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Country | US
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Telephone | 612-262-1166
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA SHEPHERD
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Credential |
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Telephone | 763-688-7804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 330760
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License Number State | MN
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