MEDICARE: YA SALAM RECOVERY

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

General Provider Information

NPI Number	:	1841040508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YA SALAM RECOVERY

Provider Business Mailing Address
First Line	:	6063 HUDSON RD STE 218-228
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-4454
Country	:	US
Telephone Number	:	651-888-7020
Fax Number	:	651-888-7029

Provider Business Practice Location Address
First Line	:	6063 HUDSON RD STE 218-228
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-4454
Country	:	US
Telephone Number	:	651-888-7020
Fax Number	:	651-888-7029

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HUSSEIN A HASSAN
Credential	:
Telephone Number	:	612-913-6133

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	01/12/2026

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Directions to “YA SALAM RECOVERY ” Practice Location

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