Organization
LAKES OPIOID TREATMENT PROGRAM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE DAWN LOSH (CO-OWNER)
(612) 877-2465
Entity
Organization
Contact information
Practice address
8381 LAKE LAND TRL NW, WALKER, MN 56484-2109
(763) 412-9441
Mailing address
15477 SODIUM ST NW, RAMSEY, MN 55303-5415
(763) 412-9441
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
09/20/2016
Last updated
10/10/2016
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