Provider Demographics
NPI: | 1861856890 |
---|---|
Name: | MINNESOTA RECOVERY CENTER L.L.C. |
Entity Type: | Organization |
Organization Name: | MINNESOTA RECOVERY CENTER L.L.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ABDULLAHI |
Authorized Official - Middle Name: | ALI |
Authorized Official - Last Name: | FARAH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 952-688-9960 |
Mailing Address - Street 1: | 8500 42ND AVE N SUITE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW HOPE |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55427 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-444-9730 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8500 42ND AVE N SUITE 100 |
Practice Address - Street 2: | |
Practice Address - City: | NEW HOPE |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55427 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-444-9730 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-04-06 |
Last Update Date: | 2016-08-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No | 251B00000X | Agencies | Case Management | |
No | 251J00000X | Agencies | Nursing Care | |
No | 251S00000X | Agencies | Community/Behavioral Health | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |