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General NPI Number Information
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NPI Number | 1336313485
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Entity Type | Organization
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Legal Business Name | DRIFENS, LLC
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Dates
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Enumeration Date | 04/19/2008
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Last Update Date | 04/19/2008
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Provider Practice Location Address
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Address Line | 3716 MAYOWOOD RD SW
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City | ROCHESTER
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State | MN
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Zip | 55902-4260
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Country | US
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Telephone | 507-288-5900
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Fax | 507-288-3539
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Provider Business Mailing Address
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Address Line | 3716 MAYOWOOD RD SW
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City | ROCHESTER
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State | MN
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Zip | 55902-4260
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Country | US
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Telephone | 507-288-5900
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Fax | 507-288-3539
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Authorized Official
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Title or Position | CEO
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Name | MR. DEREK JOEL MAZULA
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Credential |
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Telephone | 507-288-5900
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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 | 1046693-1-CDT
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License Number State | MN
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