Provider Demographics
NPI:1871643908
Name:ADDICTION RECOVERY TECHNOLOGIES OF ROCHESTER, LLC
Entity type:Organization
Organization Name:ADDICTION RECOVERY TECHNOLOGIES OF ROCHESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:507-893-4663
Mailing Address - Street 1:903 W CENTER ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-6278
Mailing Address - Country:US
Mailing Address - Phone:507-280-8826
Mailing Address - Fax:507-424-2954
Practice Address - Street 1:903 W CENTER ST
Practice Address - Street 2:SUITE 230
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-6278
Practice Address - Country:US
Practice Address - Phone:507-280-8826
Practice Address - Fax:507-424-2954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1039894-1-CDT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1039894-1-CDTOtherFACILITY LICENSE NUMBER
MN1039894-1-CDTOtherFACILITY LICENSE NUMBER