Provider Demographics
NPI:1831213420
Name:CHRISTIAN RECOVERY CENTER
Entity type:Organization
Organization Name:CHRISTIAN RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEWILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-566-0088
Mailing Address - Street 1:3533 ENSIGN AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1725
Mailing Address - Country:US
Mailing Address - Phone:763-546-0152
Mailing Address - Fax:
Practice Address - Street 1:6120 EARLE BROWN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2123
Practice Address - Country:US
Practice Address - Phone:763-566-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty