Provider Demographics
NPI:1134015720
Name:PELIME RECOVERY SERVICES, LLC
Entity type:Organization
Organization Name:PELIME RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LADC
Authorized Official - Phone:952-392-9219
Mailing Address - Street 1:11118 XYLON AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3706
Mailing Address - Country:US
Mailing Address - Phone:952-392-9219
Mailing Address - Fax:
Practice Address - Street 1:11118 XYLON AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3706
Practice Address - Country:US
Practice Address - Phone:952-392-9219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAMETTA HALL DBA PELIME RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty