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General NPI Number Information
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NPI Number | 1023293503
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Entity Type | Organization
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Legal Business Name | LIFE IN RECOVERY, LLC.
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 304 8TH ST SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3241
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Country | US
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Telephone | 320-360-4755
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Fax | 320-632-2781
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Provider Business Mailing Address
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Address Line | 304 8TH ST SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3241
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Country | US
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Telephone | 320-360-4755
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Fax | 320-632-2781
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Authorized Official
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Title or Position | OWNER
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Name | DOREEN MARIE LOOMIS
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Credential |
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Telephone | 320-632-2598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 9021
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License Number State | MN
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