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General NPI Number Information
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NPI Number | 1730791393
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Entity Type | Organization
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Legal Business Name | CRECER SERVICES
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 220 ROBERT ST S STE 103
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City | SAINT PAUL
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State | MN
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Zip | 55107-1626
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Country | US
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Telephone | 612-387-9062
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 MUMFORD RD
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2658
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Country | US
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Telephone | 612-387-9062
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ELIZABETH ELIDA BURGOS
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Credential | LICSW
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Telephone | 612-387-9062
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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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