MEDICARE: RECOVERY HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245982651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	1310 81ST AVE NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2116
Country	:	US
Telephone Number	:	952-495-2863
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 81ST AVE NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2116
Country	:	US
Telephone Number	:	952-495-2863
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CORAZON GAILOR
Credential	:
Telephone Number	:	952-495-2863

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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