Provider Demographics
NPI:1073058640
Name:A PLACE FOR HOPE: RECOVERY AND WELLNESS CENTER
Entity Type:Organization
Organization Name:A PLACE FOR HOPE: RECOVERY AND WELLNESS CENTER
Other - Org Name:THE SOCIAL CONNEXTION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-284-6069
Mailing Address - Street 1:2419 12TH AVE S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3828
Mailing Address - Country:US
Mailing Address - Phone:218-284-6069
Mailing Address - Fax:218-284-1146
Practice Address - Street 1:2419 12TH AVE S
Practice Address - Street 2:SUITE 1
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3828
Practice Address - Country:US
Practice Address - Phone:218-284-6069
Practice Address - Fax:218-284-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health