Organization
AMAZING GRACE RECOVERY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LEADENS MA, LADC (PRESIDENT/CEO)
(651) 343-3670
Entity
Organization
Contact information
Practice address
23671 SAINT FRANCIS BLVD NW, SAINT FRANCIS, MN 55070-9802
(651) 343-3670
Mailing address
35619 HELIUM ST NW, PRINCETON, MN 55371-4791
(651) 343-3670
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1093306
MN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
1093306
MN
Other
Enumeration date
07/04/2018
Last updated
07/04/2018
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