Healthcare Provider Details

I. General information

NPI: 1598323453
Provider Name (Legal Business Name): REFINE SERVICE COORDINATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 4TH ST SW
MEDFORD MN
55049-9568
US

IV. Provider business mailing address

512 4TH ST SW
MEDFORD MN
55049-9568
US

V. Phone/Fax

Practice location:
  • Phone: 507-210-8695
  • Fax:
Mailing address:
  • Phone: 507-210-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: TRACY LEE SUNDE
Title or Position: CEO
Credential: LADC
Phone: 507-210-8695