Healthcare Provider Details

I. General information

NPI: 1912333444
Provider Name (Legal Business Name): GROUPWORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 HOLLINGER ST
PARK RAPIDS MN
56470
US

IV. Provider business mailing address

1003 HOLLINGER ST
PARK RAPIDS MN
56470
US

V. Phone/Fax

Practice location:
  • Phone: 218-366-2636
  • Fax: 218-366-2087
Mailing address:
  • Phone: 218-366-2636
  • Fax: 218-366-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN R PAPPAS
Title or Position: CLINICAL SOCIAL WORKER/CO-OWNER
Credential: MSW, LICSW, DBTC
Phone: 218-366-2636