Healthcare Provider Details

I. General information

NPI: 1447005202
Provider Name (Legal Business Name): RECOVERY ACADEMY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 SUMMIT AVE
SAINT PAUL MN
55105-3354
US

IV. Provider business mailing address

1295 NORTHLAND DR
MENDOTA HEIGHTS MN
55120-1371
US

V. Phone/Fax

Practice location:
  • Phone: 339-300-4549
  • Fax: 651-305-0708
Mailing address:
  • Phone: 612-900-7021
  • Fax: 612-216-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMIR STEVAN UTRZAN
Title or Position: PRESIDENT AND CEO
Credential: PH.D., LMFT
Phone: 612-900-7021