| A Way Out Recovery Inc | |
|
1240 3rd Ave E Ste 107 Shakopee MN 55379-1749 | |
| (612) 916-8770 | |
| Not Available |
| Full Name | A Way Out Recovery Inc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1240 3rd Ave E Ste 107, Shakopee, Minnesota |
| Authorized Official Name and Position | Derrick Wade Haase (PRESIDENT) |
| Authorized Official Contact | 6129168770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Way Out Recovery Inc 1240 3rd Ave E Ste 107 Shakopee MN 55379-1749 Ph: () - | A Way Out Recovery Inc 1240 3rd Ave E Ste 107 Shakopee MN 55379-1749 Ph: (612) 916-8770 |
| NPI Number | 1255978490 |
|---|---|
| Provider Enumeration Date | 12/06/2019 |
| Last Update Date | 09/20/2021 |
| Certification Date | 09/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255978490 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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