MEDICARE: TWIN CITIES RECOVERY GYM & WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist
3	1041C0700X	Clinical Social Worker
4	171400000X	Health & Wellness Coach
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
6	374700000X	Technician
7	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1487227161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN CITIES RECOVERY GYM & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	15392 60TH AVE N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-4541
Country	:	US
Telephone Number	:	612-720-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 N 2ND ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-1606
Country	:	US
Telephone Number	:	612-720-5599
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	CRYSTAL RAE HILL
Credential	:	MBA, CPRS
Telephone Number	:	612-720-5599

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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