Provider Demographics
NPI:1760889851
Name:FAITH FAMILY RECOVERY CENTER OF MAPLE GROVE
Entity Type:Organization
Organization Name:FAITH FAMILY RECOVERY CENTER OF MAPLE GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:BCC, LADC
Authorized Official - Phone:651-437-1628
Mailing Address - Street 1:1303 S FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2483
Mailing Address - Country:US
Mailing Address - Phone:651-437-1628
Mailing Address - Fax:651-437-4165
Practice Address - Street 1:6240 QUINWOOD LN N STE 206
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6384
Practice Address - Country:US
Practice Address - Phone:763-308-4753
Practice Address - Fax:763-308-4531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH FAMILY RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility