NPI: 1023032703
Provider Name: CLUB RECOVERY LLC
Doing Business As: CLUB RECOVERY
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization
Specialization: Rehabilitation, Substance Use Disorder
CLIA Number: 24D2037418
Address:
6550 YORK AVE S
SUITE 620
EDINA, MN
ZIP 55435
Phone: (952) 926-2526
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CLUB RECOVERY LLC is a rehabilitation and substance use disorder clinic center in Edina, MN. CLUB RECOVERY LLC NPI is 1023032703. The provider is registered as an organization entity type.
The provider Is Doing Business As Club Recovery.
The provider's business location address is:
6550 YORK AVE S
SUITE 620
EDINA, MN
ZIP 55435-347
Phone: (952) 926-2526
Fax: (952) 926-6791
The provider's authorized official is Orrin R. Tietz .
The authorized official title is Administrative Director and has the following contact phone number (952) 926-2526.
The CLIA number assigned to this NPI record is 24D2037418 - other - outpatient substance abus with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 7/27/2006 and was last updated on 8/22/2020.