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General NPI Number Information
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NPI Number | 1932468683
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Entity Type | Organization
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Legal Business Name | LAKEWOOD HEALTH SYSTEM
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 401 PRAIRIE AVE. N. 49725 CO. HWY 83
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City | STAPLES
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State | MN
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Zip | 56479
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Country | US
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Telephone | 218-894-8204
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Fax | 218-894-8219
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Provider Business Mailing Address
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Address Line | 401 PRAIRIE AVE. N. 49725 CO. HWY 83
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City | STAPLES
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State | MN
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Zip | 56479
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Country | US
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Telephone | 218-894-8204
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Fax | 218-894-8219
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Authorized Official
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Title or Position | COUNSELOR
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Name | NANCY J RACH
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Credential | MS
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Telephone | 218-640-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | CC00293
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | CC00293
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | CC00293
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License Number State | MN
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