Organization
VAIL PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE COCHRAN ZUZEK LICSW (DIRECTOR OF COMPLIANCE AND CONTRACT)
(952) 945-4250
Entity
Organization
Contact information
Practice address
23 9TH AVE S, HOPKINS, MN 55343-7629
(952) 938-9622
(952) 938-7934
Mailing address
23 9TH AVE S, HOPKINS, MN 55343-7629
(952) 938-9622
(952) 938-7934
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
956400400
—
MN
Enumeration date
01/29/2007
Last updated
02/25/2016
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