Provider Demographics
NPI:1033678388
Name:RECOVERY CENTER LLC
Entity type:Organization
Organization Name:RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:320-243-1599
Mailing Address - Street 1:109 WASHBURNE AVE
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-1640
Mailing Address - Country:US
Mailing Address - Phone:320-243-1599
Mailing Address - Fax:
Practice Address - Street 1:109 WASHBURNE AVE
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1640
Practice Address - Country:US
Practice Address - Phone:320-243-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-17
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty