Provider Demographics
NPI:1932468683
Name:LAKEWOOD HEALTH SYSTEM
Entity Type:Organization
Organization Name:LAKEWOOD HEALTH SYSTEM
Other - Org Name:NORTHERN PINES MENTAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RACH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:218-640-1992
Mailing Address - Street 1:401 PRAIRIE AVE. N.
Mailing Address - Street 2:49725 CO. HWY 83
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479
Mailing Address - Country:US
Mailing Address - Phone:218-894-8204
Mailing Address - Fax:218-894-8219
Practice Address - Street 1:401 PRAIRIE AVE. N.
Practice Address - Street 2:49725 CO. HWY 83
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479
Practice Address - Country:US
Practice Address - Phone:218-894-8204
Practice Address - Fax:218-894-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00293261QM0850X, 282NC0060X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No302R00000XManaged Care OrganizationsHealth Maintenance Organization