1942780960 NPI number — RECOVERING HOPE TREATMENT CENTER, INC.

Table of content: (NPI 1942780960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942780960 NPI number — RECOVERING HOPE TREATMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERING HOPE TREATMENT CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RECOVERING HOPE OUTPATIENT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942780960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2031 ROWLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55051-7119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-364-1315
Provider Business Mailing Address Fax Number:
320-364-1320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2031 ROWLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55051-7119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-364-1315
Provider Business Practice Location Address Fax Number:
320-364-1320
Provider Enumeration Date:
08/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LUDOWESE
Authorized Official First Name:
JENNA
Authorized Official Middle Name:
KAREN
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
320-364-1314

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 821605200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 752680200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 963490100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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