Healthcare Provider Details

I. General information

NPI: 1245175389
Provider Name (Legal Business Name): LAKE REGION HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S CASCADE ST
FERGUS FALLS MN
56537-2913
US

IV. Provider business mailing address

712 S CASCADE ST
FERGUS FALLS MN
56537-2913
US

V. Phone/Fax

Practice location:
  • Phone: 218-736-8000
  • Fax:
Mailing address:
  • Phone: 218-736-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRIS JOHNSON
Title or Position: CFO
Credential:
Phone: 218-736-8687