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NPI Code Detail

MEDICARE: TWIN CITIES RECOVERY CENTER LLC

MEDICARE: TWIN CITIES RECOVERY CENTER 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1376162941
Entity Type Code : Organization
Provider Name (Legal Business Name) : TWIN CITIES RECOVERY CENTER LLC
Provider Business Mailing Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 612-226-0907
Fax Number :
Provider Business Practice Location Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 612-226-0907
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : OBSA MOHAMED
Credential :
Telephone Number : 612-226-0907
Provider Enumeration Date : 04/13/2020
Last Update Date : 08/06/2020

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Directions to “TWIN CITIES RECOVERY CENTER LLC ” Practice Location

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