Organization
FIVE STARS RECOVERY CENTER
Active
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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