Provider Demographics
NPI:1386936805
Name:AVANTI CENTER FOR GIRLS
Entity type:Organization
Organization Name:AVANTI CENTER FOR GIRLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:763-753-2500
Mailing Address - Street 1:10300 FLANDERS ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5710
Mailing Address - Country:US
Mailing Address - Phone:763-230-7470
Mailing Address - Fax:763-230-7478
Practice Address - Street 1:10300 FLANDERS ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5710
Practice Address - Country:US
Practice Address - Phone:763-230-7470
Practice Address - Fax:763-230-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children