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General NPI Number Information
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NPI Number | 1821491465
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Entity Type | Organization
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Legal Business Name | COCHRAN RECOVERY SERVICES, INC.
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 1294 18TH ST E BLDG. 2
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City | HASTINGS
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State | MN
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Zip | 55033-3680
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Country | US
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Telephone | 651-437-4209
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Fax | 651-438-4144
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Provider Business Mailing Address
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Address Line | 1294 18TH ST E BLDG. 2
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City | HASTINGS
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State | MN
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Zip | 55033-3680
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Country | US
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Telephone | 651-437-4209
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Fax | 651-438-4144
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RICHARD A TERZICK
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Credential | MA
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Telephone | 651-437-4209
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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 | 10337902DS
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License Number State | MN
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