| Recovery Alliance Llc | |
|
1421 Park Ave Ste 202 Minneapolis MN 55404-1579 | |
| (612) 226-0907 | |
| Not Available |
| Full Name | Recovery Alliance Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1421 Park Ave Ste 202, Minneapolis, Minnesota |
| Authorized Official Name and Position | Obsa Mohamed (CEO) |
| Authorized Official Contact | 6122260907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Recovery Alliance Llc 1421 Park Ave Ste 202 Minneapolis MN 55404-1579 Ph: (612) 226-0907 | Recovery Alliance Llc 1421 Park Ave Ste 202 Minneapolis MN 55404-1579 Ph: (612) 226-0907 |
| NPI Number | 1285258111 |
|---|---|
| Provider Enumeration Date | 06/06/2020 |
| Last Update Date | 06/06/2020 |
| Certification Date | 06/06/2020 |
| Medicare PECOS PAC ID | 7719361724 |
|---|---|
| Medicare Enrollment ID | O20220824003526 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285258111 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sumitra L Dorner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962692798 PECOS PAC ID: 8628262490 Enrollment ID: I20101105000388 |
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