Organization Name: | FIVE STAR RECOVERY CENTER |
NPI Number: | 1235237199 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASON DAVID VANDERSCOFF (MANAGING DIRECTOR) |
Mailing Address: | 102 E 2nd St Suite 110b Chaska |
State: | MN US |
Postal Code: | 553181966 |
Phone Number: | 9524486557 |
Fax Number: | 9524486047 |
NPI Enumeration Date: | 09/21/2006 |
NPI Last Update Date: | 11/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |