Healthcare Provider Details

I. General information

NPI: 1669819280
Provider Name (Legal Business Name): RECOVER HEALTH RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 AMERICAN BLVD W SUITE 1500
BLOOMINGTON MN
55431-4420
US

IV. Provider business mailing address

3800 AMERICAN BLVD W SUITE 1500
BLOOMINGTON MN
55431-4420
US

V. Phone/Fax

Practice location:
  • Phone: 612-844-9050
  • Fax:
Mailing address:
  • Phone: 612-844-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: FAYSAL ABDIAZIZ AHMED
Title or Position: PRESIDENT
Credential:
Phone: 763-913-8054