Provider Demographics
NPI:1801420039
Name:RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:RECOVERY CENTER LLC
Other - Org Name:RECOVERY CENTER 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-296-1121
Mailing Address - Street 1:109 W JAMES ST
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-1216
Mailing Address - Country:US
Mailing Address - Phone:320-296-1121
Mailing Address - Fax:
Practice Address - Street 1:109 W JAMES ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1216
Practice Address - Country:US
Practice Address - Phone:320-296-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-26
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty