Provider Demographics
NPI:1386117968
Name:RADICAL RECOVERY LLC
Entity type:Organization
Organization Name:RADICAL RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAFRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:218-277-8560
Mailing Address - Street 1:2323 16TH AVE S STE 308
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3862
Mailing Address - Country:US
Mailing Address - Phone:218-284-1515
Mailing Address - Fax:218-213-8917
Practice Address - Street 1:2323 16TH AVE S STE 308
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3862
Practice Address - Country:US
Practice Address - Phone:218-284-1515
Practice Address - Fax:218-213-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty