Healthcare Provider Details

I. General information

NPI: 1902994866
Provider Name (Legal Business Name): THE LAKES REGION MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BEACON ST E
LACONIA NH
03246-3437
US

IV. Provider business mailing address

40 BEACON ST E
LACONIA NH
03246-3437
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-1100
  • Fax: 603-527-8113
Mailing address:
  • Phone: 603-524-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL FERREN
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 603-524-1100