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General NPI Number Information
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NPI Number | 1528863958
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Entity Type | Organization
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Legal Business Name | CENTRAL LAKES RECUPERATIVE CARE
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1529 WENTWORTH AVE
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City | SOUTH ST PAUL
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State | MN
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Zip | 55075-1668
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Country | US
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Telephone | 612-310-3806
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 WENTWORTH AVE
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City | SOUTH ST PAUL
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State | MN
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Zip | 55075-1668
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Country | US
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Telephone | 612-310-3806
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LAKEESHA JONES
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Credential |
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Telephone | 612-310-3806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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