Northern Lights Athlete Village

NPI #1376727735 in Bloomington, Minnesota

Provider Information

NPI Number: 1376727735
Entity Type: Organization
Organization Name: Northern Lights Athlete Village
Primary Specialty: Case Management
Enumeration Date: Dec 20, 2007
Last Updated: Dec 20, 2007

Practice Location

Address: 8109 BRYANT AVE S
City: Bloomington
State: Minnesota
ZIP Code: 55420-5711
Phone: (952) 888-4311

Authorized Official

Name: MRS. STEPHANIE SMITH, ATC
Title: CEO
Phone: (952) 888-4311

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Management	251B00000X	Primary

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