CLUB RECOVERY LLC NPI 1023032703

NPI Information

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 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.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.