Organization
AVIVO
Active
Other names
Spectrum Community Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MATTER (CEO)
(612) 752-8204
Entity
Organization
Contact information
Practice address
1825 CHICAGO AVE, MINNEAPOLIS, MN 55404-1939
(612) 752-8200
(612) 752-8201
Mailing address
1900 CHICAGO AVE, MINNEAPOLIS, MN 55404-1903
(612) 752-8000
(612) 752-8001
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135355104
—
MN
Enumeration date
03/21/2008
Last updated
12/11/2023
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