MEDICARE: ELITE RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		MN
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1679949044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE RECOVERY LLC

Provider Business Mailing Address
First Line	:	1137 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2629
Country	:	US
Telephone Number	:	651-698-7358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1137 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2629
Country	:	US
Telephone Number	:	651-698-7358
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW RYAN HOROWITZ
Credential	:
Telephone Number	:	612-500-1269

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	10/14/2025

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