Willow Bridge Recovery, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

WILLOW BRIDGE RECOVERY, LLC

Practice address

17 2ND St N
Long Prairie, MN 56347-1117

Phone

(320) 357-3466

Fax

(320) 357-3468

NPI assigned

Jun 6, 2007

Last updated

Apr 6, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michele A Buer

Title

Director

Phone

(320) 357-3466

Specialties & licenses 7

Addresses

Other identifiers 2

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1386847515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 56",
            "city": "LONG PRAIRIE",
            "state": "MN",
            "postal_code": "563470056",
            "telephone_number": "320-357-3466",
            "fax_number": "320-357-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 2ND ST N",
            "city": "LONG PRAIRIE",
            "state": "MN",
            "postal_code": "563471117",
            "telephone_number": "320-357-3466",
            "fax_number": "320-357-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW BRIDGE RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "BUER",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "320-357-3466"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "MN",
            "license": "1039454-1-CRF",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHILDRENS RESIDENTIAL",
            "identifier": "026491100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NON RESIDENTIAL SUD TREATMENT PROGRAM",
            "identifier": "1107320",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Long Prairie, MN
• Providers in Long Prairie, MN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; 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.