Healthcare Provider Details

I. General information

NPI: 1396659900
Provider Name (Legal Business Name): PRIME RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

20175 COUNTY ROAD 50
CORCORAN MN
55340-9345
US

IV. Provider business mailing address

20175 COUNTY ROAD 50
CORCORAN MN
55340-9345
US

V. Phone/Fax

Practice location:
  • Phone: 651-374-9026
  • Fax: 612-642-2526
Mailing address:
  • Phone: 651-374-9026
  • Fax: 612-642-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHAD L ROBRAN
Title or Position: OWNER
Credential:
Phone: 612-965-7539