Ethos Recovery Clinic, Inc.

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

ETHOS RECOVERY CLINIC, INC.

Practice address

7766 Highway 65 NE
Spring Lake Park, MN 55432-2832

Phone

(612) 670-7769

NPI assigned

Dec 23, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Charles Bernard Hilger Jr., LADC

Title

Ceo

Phone

(612) 670-7769

Specialties & licenses 1

Addresses

Tax ID family

Ethos Recovery Clinic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ethos Recovery Clinic, Inc.

  • Methadone Clinic
  • Minneapolis, MN
  • NPI 1255047650
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Ethos Recovery Clinic, Inc.

  • Methadone Clinic
  • Minneapolis, MN
  • NPI 1255047650
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671753600000",
    "number": "1033821848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7766 HIGHWAY 65 NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322832",
            "telephone_number": "612-670-7769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7766 HIGHWAY 65 NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322832",
            "telephone_number": "612-670-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHOS RECOVERY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-23",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A",
        "authorized_official_last_name": "HILGER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-670-7769",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cliff Dahlberg, MSW, LGSW, LADC
• Deanne Den Hartog, LMFT
• Destiny Residential Services
• Patricia Jean Dickmann, M.D.
• Rachel Eiler
• Family Strengths LLC
• Rakia Abdi Farah
• Ruweydo Farah
• John Dwight Ferguson, LICSW
• Bruce H Field, MD

• Methadone Clinic in Spring Lake Park, MN
• Providers in Spring Lake Park, MN by specialty
• Methadone Clinic in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.