Healthcare Provider Details

I. General information

NPI: 1144462219
Provider Name (Legal Business Name): LAKELAND HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11855 ULYSSES ST NE STE 200
BLAINE MN
55434-4181
US

IV. Provider business mailing address

10600 OLD COUNTY ROAD 15 STE 140
PLYMOUTH MN
55441-6201
US

V. Phone/Fax

Practice location:
  • Phone: 763-576-9068
  • Fax: 763-576-1660
Mailing address:
  • Phone: 763-512-1551
  • Fax: 763-512-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMN

VIII. Authorized Official

Name: GEORGE OMAE
Title or Position: CEO & PRESIDENT
Credential:
Phone: 763-354-7648