| Avivo | |
|
1900 Chicago Ave Minneapolis MN 55404-1903 | |
| (612) 752-8000 | |
| (612) 752-8001 |
| Full Name | Avivo |
|---|---|
| Speciality | Case Management |
| Location | 1900 Chicago Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Kelly Matter (CEO) |
| Authorized Official Contact | 6127528052 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avivo 1900 Chicago Ave Minneapolis MN 55404-1903 Ph: (612) 752-8000 | Avivo 1900 Chicago Ave Minneapolis MN 55404-1903 Ph: (612) 752-8000 |
| NPI Number | 1629122924 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 12/11/2023 |
| Certification Date | 12/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629122924 | NPI | - | NPPES |
| 859255100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 801609-2-CDT (Minnesota) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
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