Healthcare Provider Details

I. General information

NPI: 1023293503
Provider Name (Legal Business Name): LIFE IN RECOVERY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 8TH ST SE
LITTLE FALLS MN
56345-3241
US

IV. Provider business mailing address

304 8TH ST SE
LITTLE FALLS MN
56345-3241
US

V. Phone/Fax

Practice location:
  • Phone: 320-360-4755
  • Fax: 320-632-2781
Mailing address:
  • Phone: 320-360-4755
  • Fax: 320-632-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number9021
License Number StateMN

VIII. Authorized Official

Name: DOREEN MARIE LOOMIS
Title or Position: OWNER
Credential:
Phone: 320-632-2598