Basic Information
| Provider Information | |||||||||
| NPI: | 1568678639 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REWIND, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REWIND CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PERHAM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565731934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183466100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 840 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PERHAM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565731934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183466100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2182338461 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | MN | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.