| Awaken Recovery Center L.l.c | |
|
400 Suite D 393 North Dunlap St Paul MN 55104 | |
| (763) 331-2162 | |
| Not Available |
| Full Name | Awaken Recovery Center L.l.c |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 400 Suite D 393 North Dunlap, St Paul, Minnesota |
| Authorized Official Name and Position | Roderick Eugene Coleman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7633312162 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awaken Recovery Center L.l.c 400 Suite D 393 North Dunlap St Paul MN 55104 Ph: (763) 331-2162 | Awaken Recovery Center L.l.c 400 Suite D 393 North Dunlap St Paul MN 55104 Ph: (763) 331-2162 |
| NPI Number | 1295219657 |
|---|---|
| Provider Enumeration Date | 09/21/2018 |
| Last Update Date | 09/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295219657 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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