Organization
A WAY OUT RECOVERY INC
Active
Other names
A Way Out Recovery Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK WADE HAASE (PRESIDENT)
(612) 916-8770
Entity
Organization
Contact information
Practice address
1240 3RD AVE E STE 107, SHAKOPEE, MN 55379-1749
(612) 916-8770
Mailing address
1240 3RD AVE E STE 107, SHAKOPEE, MN 55379-1749
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/06/2019
Last updated
09/20/2021
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