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Organization
SENIOR RECOVERY PROGRAM
Active
Organization
SENIOR RECOVERY PROGRAM
Active
Other names
Senior Chemical Dependency Counseling and Assistance Association
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN T. CLAWSON (EXECUTIVE DIRECTOR)
(651) 773-0473
Entity
Organization
Contact information
Practice address
2375 ARIEL AVE., MAPLEWOOD, MN 55109
(651) 773-0473
Mailing address
2375 ARIEL AVE., MAPLEWOOD, MN 55109
(651) 773-0473
(651) 773-9298
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
808754-3-CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
446517200
CONSOLIDATED FUND
MN
01
—
808754
RULE 31 CLINIC DEPT OF HUMAN SERVICES
MN
Enumeration date
10/21/2006
Last updated
10/30/2009
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