Provider Demographics
NPI:1821556614
Name:MINNESOTA RECOVERY CONNECTION
Entity Type:Organization
Organization Name:MINNESOTA RECOVERY CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PEER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DA'SHAY
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPRS
Authorized Official - Phone:651-321-1100
Mailing Address - Street 1:2446 UNIVERSITY AVE W STE 112
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1740
Mailing Address - Country:US
Mailing Address - Phone:612-584-4158
Mailing Address - Fax:612-886-3940
Practice Address - Street 1:2446 UNIVERSITY AVE W STE 112
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1740
Practice Address - Country:US
Practice Address - Phone:612-584-4158
Practice Address - Fax:612-886-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty