| Senior Recovery Program | |
|
2375 Ariel Ave. Maplewood MN 55109 | |
| (651) 773-0473 | |
| Not Available |
| Full Name | Senior Recovery Program |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2375 Ariel Ave., Maplewood, Minnesota |
| Authorized Official Name and Position | John T. Clawson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6517730473 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Senior Recovery Program 2375 Ariel Ave. Maplewood MN 55109 Ph: (651) 773-0473 | Senior Recovery Program 2375 Ariel Ave. Maplewood MN 55109 Ph: (651) 773-0473 |
| NPI Number | 1598848939 |
|---|---|
| Provider Enumeration Date | 10/21/2006 |
| Last Update Date | 10/30/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598848939 | NPI | - | NPPES |
| 808754 | Other | MN | RULE 31 CLINIC DEPT OF HUMAN SERVICES |
| 446517200 | Other | MN | CONSOLIDATED FUND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 808754-3-CDT (Minnesota) | Primary |
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