Provider Demographics
NPI:1992390561
Name:MEND RECOVERY SERVICES LLC
Entity Type:Organization
Organization Name:MEND RECOVERY SERVICES LLC
Other - Org Name:MEND RECOVERY SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-774-1080
Mailing Address - Street 1:1908 KRUCHTEN CT S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4645
Mailing Address - Country:US
Mailing Address - Phone:320-774-1083
Mailing Address - Fax:320-406-1308
Practice Address - Street 1:1908 KRUCHTEN CT S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4645
Practice Address - Country:US
Practice Address - Phone:320-774-1080
Practice Address - Fax:320-774-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty