Healthcare Provider Details

I. General information

NPI: 1801268354
Provider Name (Legal Business Name): MIDWEST RECOVERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 E 82ND ST STE 335
BLOOMINGTON MN
55425-1682
US

IV. Provider business mailing address

2626 E 82ND ST STE 335
BLOOMINGTON MN
55425-1682
US

V. Phone/Fax

Practice location:
  • Phone: 612-584-4860
  • Fax: 612-444-3292
Mailing address:
  • Phone: 612-584-4858
  • Fax: 612-444-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J MCHUGH
Title or Position: PRESIDENT
Credential:
Phone: 612-584-4858