Provider Demographics
NPI:1821491465
Name:COCHRAN RECOVERY SERVICES, INC.
Entity Type:Organization
Organization Name:COCHRAN RECOVERY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:TERZICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:651-437-4209
Mailing Address - Street 1:1294 18TH ST E
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3680
Mailing Address - Country:US
Mailing Address - Phone:651-437-4209
Mailing Address - Fax:651-438-4144
Practice Address - Street 1:1294 18TH ST E
Practice Address - Street 2:BLDG. 2
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3680
Practice Address - Country:US
Practice Address - Phone:651-437-4209
Practice Address - Fax:651-438-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10337902DS324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1134394828Medicaid