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Organization
RAMSEY COUNTY D.B.A. LAKE OWASSO RESIDENCE
Active
Organization
RAMSEY COUNTY D.B.A. LAKE OWASSO RESIDENCE
Active
Other names
Lake Owasso Residence
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS MICHAEL SPEGGEN MS (ADMINISTRATOR)
(651) 765-7703
Entity
Organization
Contact information
Practice address
210 N OWASSO BLVD, SHOREVIEW, MN 55126-3074
(651) 765-7700
(651) 765-7722
Mailing address
210 N OWASSO BLVD, SHOREVIEW, MN 55126-3074
(651) 765-7700
(651) 765-7722
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
801333-1-RS
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
436843600
—
MN
Enumeration date
12/05/2006
Last updated
06/19/2008
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