Provider Demographics
NPI:1912184722
Name:TEEN FOCUS RECOVERY CENTER
Entity Type:Organization
Organization Name:TEEN FOCUS RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KUZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-358-4065
Mailing Address - Street 1:475 SOUTH DANA AVENUE
Mailing Address - Street 2:P.O. BOX 106
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:475 SOUTH DANA AVEN
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069
Practice Address - Country:US
Practice Address - Phone:320-358-4065
Practice Address - Fax:320-358-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1047832251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health