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General NPI Number Information
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NPI Number | 1851150825
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Entity Type | Organization
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Legal Business Name | MINNESOTA RECUPERATIVE CARE LLC
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 16600 40TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55446-2687
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Country | US
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Telephone | 763-443-2112
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 E FRANKLIN AVE STE 119
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-2982
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Country | US
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Telephone | 763-443-2112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUDHIR K SINGH
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Credential |
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Telephone | 176-344-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 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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