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General NPI Number Information
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NPI Number | 1235926601
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Entity Type | Organization
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Legal Business Name | RECOVERYDE LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 614 4TH ST NE
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City | MONTGOMERY
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State | MN
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Zip | 56069-1412
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Country | US
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Telephone | 507-412-3919
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Fax | 507-412-3919
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Provider Business Mailing Address
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Address Line | 614 4TH ST NE
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City | MONTGOMERY
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State | MN
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Zip | 56069-1412
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Country | US
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Telephone | 507-412-3919
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Fax | 507-412-3919
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Authorized Official
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Title or Position | PEER RECOVERY SPECIALIST
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Name | MR. SEAN M BOSQUEZ
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Credential | CPRS
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Telephone | 507-412-3919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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