Provider Demographics
NPI:1700293867
Name:DIMENSIONS IN RECOVERY II
Entity Type:Organization
Organization Name:DIMENSIONS IN RECOVERY II
Other - Org Name:MAPLE LAKE RECOVERY CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FEENSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:612-501-1197
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358-0308
Mailing Address - Country:US
Mailing Address - Phone:612-501-1197
Mailing Address - Fax:
Practice Address - Street 1:13637 60TH ST SW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4210
Practice Address - Country:US
Practice Address - Phone:612-267-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAPLE LAKE RECOVERY CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1074026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty