Provider Demographics
NPI:1972318277
Name:AWAKEN RECUPERATIVE CARE LLC
Entity type:Organization
Organization Name:AWAKEN RECUPERATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIMO
Authorized Official - Middle Name:SADE
Authorized Official - Last Name:AFYARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-876-5236
Mailing Address - Street 1:847 GRIGGS ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1462
Mailing Address - Country:US
Mailing Address - Phone:612-876-5236
Mailing Address - Fax:
Practice Address - Street 1:847 GRIGGS ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1462
Practice Address - Country:US
Practice Address - Phone:612-876-5236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center