Healthcare Provider Details

I. General information

NPI: 1598679003
Provider Name (Legal Business Name): VIRA RECOVERY RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13048 JAY ST NW
COON RAPIDS MN
55448-7015
US

IV. Provider business mailing address

34 13TH AVE NE
MINNEAPOLIS MN
55413-1002
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

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