Path to Recovery LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PATH TO RECOVERY LLC

Practice address

1240 3Rd Ave E Ste 107
Shakopee, MN 55379-1749

Phone

(952) 324-5146

Fax

(952) 456-8456

NPI assigned

Jun 14, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Abdirahman Shariff Omar

Title

Administrator

Phone

(612) 999-8057

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686700800000",
    "number": "1467136895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 3RD AVE E STE 107",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553791749",
            "telephone_number": "952-324-5146",
            "fax_number": "952-456-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 3RD AVE E STE 107",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553791749",
            "telephone_number": "952-324-5146",
            "fax_number": "952-456-8456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATH TO RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-14",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A",
        "authorized_official_last_name": "OMAR",
        "authorized_official_first_name": "ABDIRAHMAN",
        "authorized_official_middle_name": "SHARIFF",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "612-999-8057",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James S Parker, MD
• Marypat Parker, M.A. CCC-SLP-L
• Melanie Parker, BA, LADC-S
• Jimeny Parks
• Meera Patel, DNP, APRN, FNP-BC
• Shelly Ann Patnaude, LPN
• PDG, P.a.
• PDG, PA
• Jennifer Margaret Pearson, DPT
• Caitlin Marie Pelletier, M.D.

• Substance Use Disorder Rehabilitation Clinic/Center in Shakopee, MN
• Providers in Shakopee, 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 Jun 14, 2023; 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.