Provider Demographics
NPI:1417026667
Name:LAKE SUPERIOR AREA FAMILY SERVICES
Entity Type:Organization
Organization Name:LAKE SUPERIOR AREA FAMILY SERVICES
Other - Org Name:GAMBLERS INTERVENTION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DENTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MGTP
Authorized Official - Phone:218-722-2273
Mailing Address - Street 1:214 W SUPERIOR ST
Mailing Address - Street 2:SKYWALK
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1904
Mailing Address - Country:US
Mailing Address - Phone:218-722-2273
Mailing Address - Fax:218-726-1183
Practice Address - Street 1:214 W SUPERIOR ST
Practice Address - Street 2:SKYWALK
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1904
Practice Address - Country:US
Practice Address - Phone:218-722-2273
Practice Address - Fax:218-726-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health