MEDICARE: KINNIC FALLS ALCOHOL-DRUG ABUSE SERVICES, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1740117589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINNIC FALLS ALCOHOL-DRUG ABUSE SERVICES, INC.

Provider Business Mailing Address
First Line	:	900 ORANGE ST
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-2819
Country	:	US
Telephone Number	:	715-426-5950
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 ORANGE ST
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-2819
Country	:	US
Telephone Number	:	715-426-5950
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION & FINANCE MANAGER
Name	:	KRISTY MATZEK
Credential	:
Telephone Number	:	715-426-5950

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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