Provider Demographics
NPI:1598768350
Name:RECOVER HEALTH OF MINNESOTA, INC.
Entity Type:Organization
Organization Name:RECOVER HEALTH OF MINNESOTA, INC.
Other - Org Name:AVEANNA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-464-8000
Mailing Address - Street 1:400 INTERSTATE NORTH PKWY SE STE 1600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5047
Mailing Address - Country:US
Mailing Address - Phone:470-464-8000
Mailing Address - Fax:
Practice Address - Street 1:302 E HOWARD ST STE 116
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1772
Practice Address - Country:US
Practice Address - Phone:218-262-5887
Practice Address - Fax:218-262-6228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVER HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328386251E00000X, 251E00000X, 251E00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN772555800Medicaid
MN772555800Medicaid
MN772555800Medicaid
247218Medicare Oscar/Certification
MN0177930001Medicare NSC