Provider Demographics
NPI:1801209697
Name:REWIND, INC
Entity Type:Organization
Organization Name:REWIND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:218-346-6100
Mailing Address - Street 1:840 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1934
Mailing Address - Country:US
Mailing Address - Phone:218-346-6100
Mailing Address - Fax:218-346-6112
Practice Address - Street 1:840 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-1934
Practice Address - Country:US
Practice Address - Phone:218-346-6100
Practice Address - Fax:218-346-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10348381CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN302032OtherLADC LICENSE