Provider Demographics
NPI:1982486999
Name:PEONY RECOVERY
Entity Type:Organization
Organization Name:PEONY RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:ADC-T
Authorized Official - Phone:612-200-2680
Mailing Address - Street 1:4424 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5006
Mailing Address - Country:US
Mailing Address - Phone:612-200-2680
Mailing Address - Fax:612-294-1080
Practice Address - Street 1:4424 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5006
Practice Address - Country:US
Practice Address - Phone:612-200-2680
Practice Address - Fax:612-294-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable