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General NPI Number Information
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NPI Number | 1780186130
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Entity Type | Organization
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Legal Business Name | ALLIANCE WELLNESS CLINIC INC.
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 8040 OLD CEDAR AVE. S. STE. 100
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1211
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Country | US
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Telephone | 952-693-0080
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Fax | 952-955-6567
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Provider Business Mailing Address
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Address Line | 8040 OLD CEDAR AVE. S. STE. 100
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1211
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Country | US
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Telephone | 952-693-0080
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Fax | 952-955-6567
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Authorized Official
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Title or Position | TREATMENT DIRECTOR
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Name | MS. PATRICIA JOANN FRIEDMAN
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Credential | LADC
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Telephone | 952-693-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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