Healthcare Provider Details

I. General information

NPI: 1194080234
Provider Name (Legal Business Name): PARTNERS IN RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2012
Last Update Date: 11/04/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 UNIVERSITY AVE W
SAINT PAUL MN
55103-1959
US

IV. Provider business mailing address

475 UNIVERSITY AVE W
SAINT PAUL MN
55103-1959
US

V. Phone/Fax

Practice location:
  • Phone: 888-648-7652
  • Fax: 651-348-8349
Mailing address:
  • Phone: 651-356-4436
  • Fax:

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: MR. CHRISTOPHER ROBIN MCCALLA
Title or Position: CEO
Credential:
Phone: 651-356-4436