Provider Demographics
NPI:1942780960
Name:RECOVERING HOPE TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:RECOVERING HOPE TREATMENT CENTER, INC.
Other - Org Name:RECOVERING HOPE OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:LUDOWESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-364-1314
Mailing Address - Street 1:2031 ROWLAND RD
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-7119
Mailing Address - Country:US
Mailing Address - Phone:320-364-1315
Mailing Address - Fax:320-364-1320
Practice Address - Street 1:2031 ROWLAND RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-7119
Practice Address - Country:US
Practice Address - Phone:320-364-1315
Practice Address - Fax:320-364-1320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERING HOPE TREATMENT CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN821605200Medicaid
MN752680200Medicaid
MN963490100Medicaid