Provider Demographics
NPI:1770248577
Name:RESTORING HOPE SUBSTANCE ABUSE & MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:RESTORING HOPE SUBSTANCE ABUSE & MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE-OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MHP, LADC
Authorized Official - Phone:320-260-4184
Mailing Address - Street 1:16405 HAVEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6400
Mailing Address - Country:US
Mailing Address - Phone:320-639-2193
Mailing Address - Fax:320-639-2197
Practice Address - Street 1:16405 HAVEN RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-6400
Practice Address - Country:US
Practice Address - Phone:320-639-2193
Practice Address - Fax:320-639-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder