Healthcare Provider Details

I. General information

NPI: 1346215084
Provider Name (Legal Business Name): LAKEWOOD HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

IV. Provider business mailing address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-2120
  • Fax: 218-634-1307
Mailing address:
  • Phone: 218-634-2120
  • Fax: 218-634-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number331065
License Number StateMN

VIII. Authorized Official

Name: SHARRAY A PALM
Title or Position: CEO
Credential:
Phone: 218-634-3401