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General NPI Number Information
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NPI Number | 1740938778
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL RECOVERY ORGANIZATION NETWORK, LLC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/20/2022
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Provider Practice Location Address
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Address Line | 1687 WOODLANE DR STE 208
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City | WOODBURY
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State | MN
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Zip | 55125-3047
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Country | US
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Telephone | 507-951-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 47842 BLUE HERON TRL
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City | RUSH CITY
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State | MN
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Zip | 55069-2803
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Country | US
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Telephone | 507-951-9980
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MELINDA RAE COSCARELLI
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Credential | PHD
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Telephone | 507-951-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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