Provider Demographics
NPI:1114751369
Name:NORTHWOODS HAVEN RECOVERY LLC
Entity type:Organization
Organization Name:NORTHWOODS HAVEN RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OHLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-465-0264
Mailing Address - Street 1:5301 E RIVER RD STE 113
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3778
Mailing Address - Country:US
Mailing Address - Phone:612-910-7243
Mailing Address - Fax:
Practice Address - Street 1:5900 GREEN OAK DR STE 306
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4708
Practice Address - Country:US
Practice Address - Phone:952-243-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health