Provider Demographics
NPI:1104606607
Name:LIONHEART WELLNESS AND RECOVERY
Entity type:Organization
Organization Name:LIONHEART WELLNESS AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUHARTH
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:651-417-1614
Mailing Address - Street 1:590 BOHLKEN DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3803
Mailing Address - Country:US
Mailing Address - Phone:651-417-1614
Mailing Address - Fax:
Practice Address - Street 1:507 VERMILLION ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1938
Practice Address - Country:US
Practice Address - Phone:651-417-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility