Provider Demographics
NPI:1033536768
Name:ADDICTION, INTERVENTION, RECOVERY, RESOURCES OF MINNESOTA
Entity Type:Organization
Organization Name:ADDICTION, INTERVENTION, RECOVERY, RESOURCES OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:952-472-3444
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:MN
Mailing Address - Zip Code:55392-0021
Mailing Address - Country:US
Mailing Address - Phone:952-472-3444
Mailing Address - Fax:
Practice Address - Street 1:2389 BLAINE AVE.
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:MN
Practice Address - Zip Code:55392-0021
Practice Address - Country:US
Practice Address - Phone:952-472-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility