Healthcare Provider Details

I. General information

NPI: 1508770017
Provider Name (Legal Business Name): VIRA RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3891 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2518
US

IV. Provider business mailing address

34 13TH AVE NE STE B004
MINNEAPOLIS MN
55413-1084
US

V. Phone/Fax

Practice location:
  • Phone: 763-200-6512
  • Fax:
Mailing address:
  • Phone: 612-559-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: HODA BASHIR
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 763-200-6512