| NPI | 1023032703 |
|---|---|
| Doing Business As | CLUB RECOVERY |
| Entity Type | Organization |
| Authorized Contact | ORRIN R. TIETZ Administrative Director 952-926-2526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MN 10043993CDT) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |