Healthcare Provider Details

I. General information

NPI: 1477544542
Provider Name (Legal Business Name): LAKEWOOD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PRAIRIE AVE NE
STAPLES MN
56479-3201
US

IV. Provider business mailing address

49725 COUNTY 83
STAPLES MN
56479-5280
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1515
  • Fax: 218-898-7596
Mailing address:
  • Phone: 218-894-1515
  • Fax: 218-898-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: JOSEPH T REYCRAFT
Title or Position: CFO
Credential:
Phone: 218-894-8194