MEDICARE: FOUR WINDS CENTER FOR WELLNESS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1609975713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR WINDS CENTER FOR WELLNESS INC

Provider Business Mailing Address
First Line	:	28141 LAKELAWN DRIVE
Second Line	:
City	:	LINDSTROM
State	:	MN
Zip	:	55045
Country	:	US
Telephone Number	:	651-257-9566
Fax Number	:

Provider Business Practice Location Address
First Line	:	28141 LAKELAWN DRIVE
Second Line	:
City	:	LINDSTROM
State	:	MN
Zip	:	55045
Country	:	US
Telephone Number	:	651-257-9566
Fax Number	:

Authorized Official
Title or Position	:	COOWNER OPERATOR
Name	:	ALAN LOUIS CIROCCO
Credential	:	MSW LICSW
Telephone Number	:	218-444-2055

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/03/2007

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