Organization
MAPLE LAKE RECOVERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH M FEENSTRA LADC (ADMINISTRATOR)
(612) 501-1197
Entity
Organization
Contact information
Practice address
207 DIVISION ST. E, MAPLE LAKE, MN 55358
(320) 963-6865
(320) 963-6279
Mailing address
P O BOX 308, 207 DIVISION ST. E, MAPLE LAKE, MN 55358
(320) 963-6865
(320) 963-6279
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
810975-1-CRF
MN
Other
Enumeration date
09/13/2006
Last updated
09/03/2008
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