Organization
FIVE STARS RECOVERY CENTER
Active
Other names
Five Stars Clinical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
JASON VANDERSCOFF LADC (CEO, MANAGING DIRECTOR)
(952) 448-6557
Entity
Organization
Contact information
Practice address
1045 STOUGHTON AVE., CHASKA, MN 55318
(952) 448-6557
(952) 448-6047
Mailing address
1045 STOUGHTON AVE., CHASKA, MN 55318
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
24D2130068
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
473724996
—
MN
Enumeration date
08/21/2017
Last updated
08/21/2017
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