Provider Demographics
NPI:1790818078
Name:HEALTH RECOVERY CENTER
Entity Type:Organization
Organization Name:HEALTH RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-827-7800
Mailing Address - Street 1:3255 HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3470
Mailing Address - Country:US
Mailing Address - Phone:612-827-7800
Mailing Address - Fax:
Practice Address - Street 1:3255 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3470
Practice Address - Country:US
Practice Address - Phone:612-827-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MN801006-2-CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty