Provider Demographics
NPI:1730791393
Name:CRECER SERVICES
Entity type:Organization
Organization Name:CRECER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ELIDA
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-387-9062
Mailing Address - Street 1:3300 MUMFORD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2658
Mailing Address - Country:US
Mailing Address - Phone:612-387-9062
Mailing Address - Fax:
Practice Address - Street 1:220 ROBERT ST S STE 103
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1626
Practice Address - Country:US
Practice Address - Phone:612-387-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility