Provider Demographics
NPI:1497958177
Name:OVERCOMERS OUTREACH MINISTRIES
Entity Type:Organization
Organization Name:OVERCOMERS OUTREACH MINISTRIES
Other - Org Name:FIRST NATIONS RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-871-1208
Mailing Address - Street 1:2020 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3073
Mailing Address - Country:US
Mailing Address - Phone:612-871-1208
Mailing Address - Fax:612-871-1219
Practice Address - Street 1:2020 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3073
Practice Address - Country:US
Practice Address - Phone:612-871-1208
Practice Address - Fax:612-871-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1010090302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization