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General NPI Number Information
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NPI Number | 1104606607
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Entity Type | Organization
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Legal Business Name | LIONHEART WELLNESS AND RECOVERY
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 507 VERMILLION ST
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City | HASTINGS
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State | MN
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Zip | 55033-1938
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Country | US
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Telephone | 651-417-1614
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Fax |
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Provider Business Mailing Address
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Address Line | 590 BOHLKEN DR
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City | HASTINGS
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State | MN
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Zip | 55033-3803
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Country | US
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Telephone | 651-417-1614
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIFFANY NEUHARTH
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Credential | LADC
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Telephone | 651-417-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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