Healthcare Provider Details

I. General information

NPI: 1114751369
Provider Name (Legal Business Name): NORTHWOODS HAVEN RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 GREEN OAK DR STE 306
MINNETONKA MN
55343-4708
US

IV. Provider business mailing address

5900 GREEN OAK DR STE 306
MINNETONKA MN
55343-4708
US

V. Phone/Fax

Practice location:
  • Phone: 952-243-8700
  • Fax: 612-484-3752
Mailing address:
  • Phone: 952-243-8700
  • Fax: 612-484-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN OHLSEN
Title or Position: GENERAL COUNSEL
Credential:
Phone: 612-465-0264