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General NPI Number Information
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NPI Number | 1558635128
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Entity Type | Organization
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Legal Business Name | WENDEN OLMSTED COUNTY CORRECTION RECOVERY SERVICE
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 140 4TH ST SE
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City | ROCHESTER
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State | MN
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Zip | 55904-3752
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Country | US
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Telephone | 651-385-0600
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Fax | 651-388-2129
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Provider Business Mailing Address
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Address Line | 217 PLUM ST #220
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City | RED WING
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State | MN
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Zip | 55066-2351
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Country | US
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Telephone | 651-385-0600
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Fax | 651-388-2129
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Authorized Official
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Title or Position | OWNER
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Name | MR. ADAM GARCIA
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Credential | LADC
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Telephone | 651-385-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1061701-1CDT
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License Number State | MN
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