Healthcare Provider Details

I. General information

NPI: 1134394828
Provider Name (Legal Business Name): COCHRAN RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WHITE BEAR AVE N
MAPLEWOOD MN
55109-3713
US

IV. Provider business mailing address

2000 WHITE BEAR AVE N
MAPLEWOOD MN
55109-3713
US

V. Phone/Fax

Practice location:
  • Phone: 651-437-4209
  • Fax:
Mailing address:
  • Phone: 651-437-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1004916-3-DS
License Number StateMN

VIII. Authorized Official

Name: TOM MEIER
Title or Position: COO
Credential:
Phone: 612-767-0313