Provider Demographics
NPI:1093340036
Name:HUMBLE RECOVERY
Entity Type:Organization
Organization Name:HUMBLE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-807-0614
Mailing Address - Street 1:1156 ALDRICH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-4248
Mailing Address - Country:US
Mailing Address - Phone:763-807-0614
Mailing Address - Fax:
Practice Address - Street 1:1156 ALDRICH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-4248
Practice Address - Country:US
Practice Address - Phone:763-807-0614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder