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General NPI Number Information
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NPI Number | 1699960807
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Entity Type | Organization
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Legal Business Name | HIAWATHA VALLEY MENTAL HEALTH CENTER INC.
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 611 BROADWAY AVE STE 100
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City | WABASHA
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State | MN
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Zip | 55981-1669
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Country | US
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Telephone | 651-565-2234
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Fax | 651-565-2890
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Provider Business Mailing Address
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Address Line | 420 E SARNIA ST STE 2100
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City | WINONA
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State | MN
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Zip | 55987-6414
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Country | US
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Telephone | 507-454-4341
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Fax | 507-453-6267
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ERIK SIEVERS
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Credential |
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Telephone | 507-454-4341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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