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Organization

LAKEVIEW BEHAVIORAL HEALTH INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS JOHNSON (CEO)
(218) 327-2001
Entity
Organization

Contact information

Practice address
516 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3800
(218) 327-2001
(218) 327-0456
Mailing address
516 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3800
(218) 327-2001
(218) 327-0456

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
805713-1-CDT
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
122307
BEHAVIORAL HEALTH
MN
05
371225700
MN
01
5042493
MEDICA
MN
01
8974RA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/23/2006
Last updated
08/20/2021
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