Provider Demographics
NPI:1225357437
Name:PEAR LAKE WOMEN'S FACILITY - OUTPATIENT
Entity Type:Organization
Organization Name:PEAR LAKE WOMEN'S FACILITY - OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-327-9944
Mailing Address - Street 1:2086 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4421
Mailing Address - Country:US
Mailing Address - Phone:218-327-9944
Mailing Address - Fax:218-327-9944
Practice Address - Street 1:2086 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4421
Practice Address - Country:US
Practice Address - Phone:218-327-9944
Practice Address - Fax:218-327-9944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE HOUSE OF ITASCA COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-27
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10026213CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty