Provider Demographics
NPI:1396598322
Name:THE RECOVERY SPACE LLC
Entity type:Organization
Organization Name:THE RECOVERY SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:612-219-5373
Mailing Address - Street 1:522 BELTRAMI AVE NW STE 11
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3181
Mailing Address - Country:US
Mailing Address - Phone:612-219-5373
Mailing Address - Fax:
Practice Address - Street 1:522 BELTRAMI AVE NW STE 11
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3181
Practice Address - Country:US
Practice Address - Phone:612-219-5373
Practice Address - Fax:218-520-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty