Provider Demographics
NPI:1962671420
Name:RECOVERY WORKS/BC JAIL HOUSE PROGRAM
Entity Type:Organization
Organization Name:RECOVERY WORKS/BC JAIL HOUSE PROGRAM
Other - Org Name:RECOVERY WORKS MINIMUM SECURITY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:TREATMENT DIRECTOR/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED/LADC
Authorized Official - Phone:218-850-1984
Mailing Address - Street 1:640 RANDOLPH ROAD
Mailing Address - Street 2:PO BOX 288
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-0288
Mailing Address - Country:US
Mailing Address - Phone:218-844-6340
Mailing Address - Fax:218-844-1984
Practice Address - Street 1:640 RANDOLPH ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56502-0288
Practice Address - Country:US
Practice Address - Phone:218-844-6340
Practice Address - Fax:218-844-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1049659-1-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty