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General NPI Number Information
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NPI Number | 1598679003
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Entity Type | Organization
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Legal Business Name | VIRA RECOVERY RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 13048 JAY ST NW
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City | COON RAPIDS
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State | MN
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Zip | 55448-7015
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Country | US
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Telephone | 763-200-6512
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Fax |
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Provider Business Mailing Address
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Address Line | 34 13TH AVE NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1002
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Country | US
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Telephone | 763-200-6512
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | HODA BASHIR
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Credential |
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Telephone | 763-200-6512
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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 | NULL
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