SENIOR RECOVERY PROGRAM NPI 1598848939

NPI Information

NPI: 1598848939
Provider Name: SENIOR RECOVERY PROGRAM

Former Legal Business Name: SENIOR CHEMICAL DEPENDENCY COUNSELING AND ASSISTANCE ASSOCIATION

Classification: Counselor - 101YA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

Address:
2375 ARIEL AVE.
MAPLEWOOD, MN
ZIP 55109
Phone: (651) 773-0473
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SENIOR RECOVERY PROGRAM is an addiction (substance use disorder) counselor in Maplewood, MN. SENIOR RECOVERY PROGRAM NPI is 1598848939. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Senior Chemical Dependency Counseling And Assistance Association.

The provider's business location address is:

2375 ARIEL AVE.
MAPLEWOOD, MN
ZIP 55109
Phone: (651) 773-0473

The provider's authorized official is John T. Clawson .
The authorized official title is Executive Director and has the following contact phone number (651) 773-0473.

The enumeration date for this NPI number is 10/21/2006 and was last updated on 10/30/2009.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	808754-3-CDT	MINNESOTA	Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	446517200	OTHER	MINNESOTA	CONSOLIDATED FUND
2	808754	OTHER	MINNESOTA	RULE 31 CLINIC DEPT OF HUMAN SERVICES

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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