Provider Demographics
NPI:1144227430
Name:LIVING FREE RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:LIVING FREE RECOVERY SERVICES, LLC
Other - Org Name:LIVING WORD CHRISTIAN CENTER DBA LIVING FREE RECOVERY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TREENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-315-7174
Mailing Address - Street 1:9201 75TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428
Mailing Address - Country:US
Mailing Address - Phone:763-315-7000
Mailing Address - Fax:763-315-7177
Practice Address - Street 1:9201 75TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428
Practice Address - Country:US
Practice Address - Phone:763-315-7000
Practice Address - Fax:763-315-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN830992-2-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN251922400Medicaid
MN0C20LIOtherBCBS OF MN
MN8442759OtherUBH - ADULT
MN8446051OtherUBH- ASSESSMENT ONLY
MN8442760OtherUBH - ADOLESCENT
FM8442761OtherUBH - RELAPSE