Provider Demographics
NPI:1437526720
Name:SE HOMES RECOVERY INC
Entity Type:Organization
Organization Name:SE HOMES RECOVERY INC
Other - Org Name:SOUTH EAST HOMES INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABAH
Authorized Official - Middle Name:ABDUL
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-702-7231
Mailing Address - Street 1:2542 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4001
Mailing Address - Country:US
Mailing Address - Phone:612-702-7231
Mailing Address - Fax:
Practice Address - Street 1:4020 MINNEHAHA AVE STE 2070
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-4529
Practice Address - Country:US
Practice Address - Phone:612-702-7231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1074798-2-CDT261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder