Provider Demographics
NPI:1144329632
Name:VINLAND NATIONAL CENTER
Entity type:Organization
Organization Name:VINLAND NATIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-479-4514
Mailing Address - Street 1:P.O. BOX 308
Mailing Address - Street 2:3675 IHDUHAPI ROAD
Mailing Address - City:LORETTO
Mailing Address - State:MN
Mailing Address - Zip Code:55357-0308
Mailing Address - Country:US
Mailing Address - Phone:763-479-3555
Mailing Address - Fax:763-479-2605
Practice Address - Street 1:3675 IHDUHAPI RD
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:MN
Practice Address - Zip Code:55357-0308
Practice Address - Country:US
Practice Address - Phone:763-479-3555
Practice Address - Fax:763-479-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10613151MHC251S00000X
261QM0801X
MN802601-3-CDT324500000X
MN1039413-1-CDT324500000X
MN10394132CDT324500000X
MN8026015CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN098055200Medicaid