Healthcare Provider Details

I. General information

NPI: 1629471099
Provider Name (Legal Business Name): COCHRAN RECOVERY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 VERMILLION ST
HASTINGS MN
55033-1237
US

IV. Provider business mailing address

1294 18TH ST E
HASTINGS MN
55033-3680
US

V. Phone/Fax

Practice location:
  • Phone: 651-438-2639
  • Fax: 651-438-2752
Mailing address:
  • Phone: 651-437-4209
  • Fax: 651-438-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number80061110CDT
License Number StateMN

VIII. Authorized Official

Name: MR. RICHARD A TERZICK
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 651-437-4209