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General NPI Number Information
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NPI Number | 1760289292
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Entity Type | Organization
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Legal Business Name | RESTORECARE
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1965 COUNTY ROAD E W
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City | SAINT PAUL
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State | MN
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Zip | 55112-7145
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Country | US
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Telephone | 612-703-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 1965 COUNTY ROAD E W
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-7145
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Country | US
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Telephone | 612-703-7465
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BAHJO H MAHAMUD
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Credential | LICSW
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Telephone | 612-703-7465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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