Provider Demographics
NPI:1245113570
Name:BLUE RIDGE RECOVER LLC
Entity type:Organization
Organization Name:BLUE RIDGE RECOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEN
Authorized Official - Middle Name:YONIS
Authorized Official - Last Name:MUQTAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-433-8355
Mailing Address - Street 1:9964 QUAKER LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3546
Mailing Address - Country:US
Mailing Address - Phone:612-433-8355
Mailing Address - Fax:
Practice Address - Street 1:9964 QUAKER LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-3546
Practice Address - Country:US
Practice Address - Phone:612-433-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center