| Partners In Recovery | |
|
1611 County Road B W Ste 102 Roseville MN 55113-4053 | |
| (651) 433-5505 | |
| Not Available |
| Full Name | Partners In Recovery |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1611 County Road B W Ste 102, Roseville, Minnesota |
| Authorized Official Name and Position | Christopher Robin Mccalla (CEO) |
| Authorized Official Contact | 6513564436 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Partners In Recovery 1611 County Road B W Ste 102 Roseville MN 55113-4053 Ph: (651) 356-4436 | Partners In Recovery 1611 County Road B W Ste 102 Roseville MN 55113-4053 Ph: (651) 433-5505 |
| NPI Number | 1194080234 |
|---|---|
| Provider Enumeration Date | 07/04/2012 |
| Last Update Date | 09/30/2021 |
| Certification Date | 09/30/2021 |
| Medicare PECOS PAC ID | 0042612012 |
|---|---|
| Medicare Enrollment ID | O20210713003306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194080234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Cynthia Packer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821214982 PECOS PAC ID: 1850338658 Enrollment ID: I20050413000614 |
| Provider Name | Jennifer R Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366743916 PECOS PAC ID: 5496930992 Enrollment ID: I20110427000331 |
| Provider Name | Muluh F Fondong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306221460 PECOS PAC ID: 1254648017 Enrollment ID: I20150911001266 |
| Provider Name | Patrick W Dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417308313 PECOS PAC ID: 2961798996 Enrollment ID: I20190508002361 |
| Provider Name | Ashley M Esse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376286294 PECOS PAC ID: 9234506924 Enrollment ID: I20221109002526 |
| Provider Name | Allett K Lykins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336867290 PECOS PAC ID: 8820460629 Enrollment ID: I20230203001009 |
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