Organization
NORTHWEST RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL DENNIS OLSON M.A., LADC (ADMINISTRATOR)
(218) 681-6561
Entity
Organization
Contact information
Practice address
115 6TH ST W, THIEF RIVER FALLS, MN 56701-1511
(218) 681-6561
(218) 681-0477
Mailing address
115 6TH ST W, THIEF RIVER FALLS, MN 56701-1511
(218) 681-6561
(218) 681-0477
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1030141
PREFERRED ONE
MN
01
—
167478
UCARE
MN
01
—
4271NO
MN BLUE CROSS
MN
01
—
5087964
MEDICA
MN
Enumeration date
11/10/2006
Last updated
08/22/2020
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