Provider Demographics
NPI:1629648258
Name:NIYYAH RECOVERY INITIATIVE
Entity Type:Organization
Organization Name:NIYYAH RECOVERY INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FARHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDUL
Authorized Official - Suffix:
Authorized Official - Credentials:CPRS, CPP
Authorized Official - Phone:161-222-6401
Mailing Address - Street 1:515 15TH AVE S UNIT 510
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1578
Mailing Address - Country:US
Mailing Address - Phone:612-226-4012
Mailing Address - Fax:612-338-8421
Practice Address - Street 1:420 15TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1114
Practice Address - Country:US
Practice Address - Phone:161-222-6401
Practice Address - Fax:612-338-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty