Organization
PATH TO RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ABDIRAHMAN SHARIFF OMAR (ADMINISTRATOR)
(612) 999-8057
Entity
Organization
Contact information
Practice address
1240 3RD AVE E STE 107, SHAKOPEE, MN 55379-1749
(952) 324-5146
(952) 456-8456
Mailing address
1240 3RD AVE E STE 107, SHAKOPEE, MN 55379-1749
(952) 324-5146
(952) 456-8456
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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