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General NPI Number Information
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NPI Number | 1376942128
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Entity Type | Organization
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Legal Business Name | GROUND ZERO SOBER LIVING L.L.C.
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 110 4TH ST NE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-2720
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Country | US
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Telephone | 218-831-5281
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Fax |
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Provider Business Mailing Address
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Address Line | 14601 LYNNDALE DR
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City | BAXTER
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State | MN
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Zip | 56425-6018
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Country | US
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Telephone | 218-831-5281
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY OLSON
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Credential |
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Telephone | 218-831-5281
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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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