Organization
SPARK RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANAD YUSSUF MOHAMED (OWNER)
(612) 702-9499
Entity
Organization
Contact information
Practice address
2375 UNIVERSITY AVE W STE 200, SAINT PAUL, MN 55114-1678
(612) 702-9499
Mailing address
2375 UNIVERSITY AVE W STE 200, SAINT PAUL, MN 55114-1678
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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