Healthcare Provider Details

I. General information

NPI: 1053603167
Provider Name (Legal Business Name): INTEGRATIONS WELLNESS & RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2011
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 HIGHWAY 7 W
HUTCHINSON MN
55350-1511
US

IV. Provider business mailing address

PO BOX 683
HUTCHINSON MN
55350-0683
US

V. Phone/Fax

Practice location:
  • Phone: 320-434-1312
  • Fax: 651-925-0087
Mailing address:
  • Phone: 320-434-1312
  • Fax: 651-925-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILL M DECKER
Title or Position: COO, TREATMENT DIRECT, MS, LPCC
Credential: MS, LPCC
Phone: 320-434-1312