Healthcare Provider Details

I. General information

NPI: 1104606607
Provider Name (Legal Business Name): LIONHEART WELLNESS AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 HIGHWAY 55 STE 101
HASTINGS MN
55033-2373
US

IV. Provider business mailing address

1112 HIGHWAY 55 STE 101
HASTINGS MN
55033-2373
US

V. Phone/Fax

Practice location:
  • Phone: 651-456-8411
  • Fax:
Mailing address:
  • Phone: 651-456-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY NEUHARTH
Title or Position: CEO
Credential: LADC
Phone: 651-417-1614