Family Focused Recovery Services PLLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

301674 Issued in MN

Legal business name

FAMILY FOCUSED RECOVERY SERVICES PLLC

Practice address

4080 W Broadway Ave
Robbinsdale, MN 55422-5604

Phone

(612) 220-8645

NPI assigned

Mar 14, 2012

Organization subpart

No

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

Authorized official

Name

Derryck Vancurk Moore, LADC

Title

Ceo

Phone

(612) 220-8645

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331683200000",
    "number": "1801161427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4080 W BROADWAY AVE",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554225604",
            "telephone_number": "612-220-8645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 W BROADWAY AVE",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554225604",
            "telephone_number": "612-220-8645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FOCUSED RECOVERY SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-14",
        "last_updated": "2012-03-14",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DERRYCK",
        "authorized_official_middle_name": "VANCURK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-220-8645",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "301674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Robbinsdale, MN
• Providers in Robbinsdale, MN by specialty
• Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; 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.