Provider Demographics
NPI:1033821848
Name:ETHOS RECOVERY CLINIC, INC.
Entity Type:Organization
Organization Name:ETHOS RECOVERY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LADC
Authorized Official - Phone:612-670-7769
Mailing Address - Street 1:7766 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2832
Mailing Address - Country:US
Mailing Address - Phone:612-670-7769
Mailing Address - Fax:
Practice Address - Street 1:7766 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2832
Practice Address - Country:US
Practice Address - Phone:612-670-7769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone