Organization
PRAIRIE LAKES YOUTH PROGRAMS GIRLS GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE K. MCGILLIVRAY (ACCOUNTS MANAGER)
(320) 235-0975
Entity
Organization
Contact information
Practice address
822 PARK AVE, WILLMAR, MN 56201-2568
(320) 235-6637
(320) 235-6659
Mailing address
1804 CIVIC CENTER DR, PO BOX 902, WILLMAR, MN 56201-9446
(320) 235-0975
(320) 214-7067
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
1049805-1-CRF
MN
Other
Enumeration date
01/23/2008
Last updated
01/23/2008
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