Healthcare Provider Details

I. General information

NPI: 1194615328
Provider Name (Legal Business Name): HEALTHRIVE RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3638 CENTRAL AVE NE UNIT B
MINNEAPOLIS MN
55418-1343
US

IV. Provider business mailing address

3638 CENTRAL AVE NE UNIT B
MINNEAPOLIS MN
55418-1343
US

V. Phone/Fax

Practice location:
  • Phone: 763-744-8280
  • Fax:
Mailing address:
  • Phone: 763-744-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DHUGUMA G BATI
Title or Position: DIRECTOR
Credential:
Phone: 763-744-8280