MEDICARE: AA ALTERNATIVES OF MINNESOTA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility	8309612 CDT	MN

General Provider Information

NPI Number	:	1003951989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AA ALTERNATIVES OF MINNESOTA INC

Provider Business Mailing Address
First Line	:	PO BOX 40502
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-8502
Country	:	US
Telephone Number	:	651-645-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2499 RICE ST STE 40
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-3724
Country	:	US
Telephone Number	:	651-645-6100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TAMARA JEAN GRAMS
Credential	:	LADC
Telephone Number	:	651-645-6100

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	06/12/2019

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