MEDICARE: RRECOVERY SERVICES

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1710505821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RRECOVERY SERVICES

Provider Business Mailing Address
First Line	:	1340 HAZEL ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4506
Country	:	US
Telephone Number	:	763-607-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 HAZEL ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4506
Country	:	US
Telephone Number	:	763-339-7506
Fax Number	:

Authorized Official
Title or Position	:	TREATMENT DIRECTOR
Name	:	MARCUS CAGE
Credential	:
Telephone Number	:	763-607-8544

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	11/14/2022

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Directions to “RRECOVERY SERVICES ” Practice Location

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