Healthcare Provider Details

I. General information

NPI: 1447092515
Provider Name (Legal Business Name): FRONTLINE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N STE 104
NEW HOPE MN
55427-1200
US

IV. Provider business mailing address

1600 18TH AVE NE UNIT 18744
MINNEAPOLIS MN
55418-5532
US

V. Phone/Fax

Practice location:
  • Phone: 763-393-6194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FADUMO AHMED
Title or Position: TREATMENT DIRECTOR
Credential:
Phone: 612-298-3306