| Rebecca Residence Scandia | |
|
21077 Penrose Ave N Scandia MN 55073-9710 | |
| (651) 433-5839 | |
| (651) 433-5921 |
| Full Name | Rebecca Residence Scandia |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 21077 Penrose Ave N, Scandia, Minnesota |
| Authorized Official Name and Position | Robert Haven (PRESIDENT) |
| Authorized Official Contact | 6517349633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rebecca Residence Scandia 2042 Wooddale Dr Suite 220 Woodbury MN 55125-2981 Ph: (651) 734-9633 | Rebecca Residence Scandia 21077 Penrose Ave N Scandia MN 55073-9710 Ph: (651) 433-5839 |
| NPI Number | 1952464547 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952464547 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1024597-1-CDT (Minnesota) | Primary |