Organization
LAKE REGION HALFWAY HOMES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHERRI E. CLARK LADC (TREATMENT DIRECTOR)
(218) 739-9084
Entity
Organization
Contact information
Practice address
217 N UNION AVE, FERGUS FALLS, MN 56537-2127
(218) 739-9084
(218) 739-0518
Mailing address
217 N UNION AVE, FERGUS FALLS, MN 56537-2127
(218) 739-9084
(218) 739-0518
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
801334-2-CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
726555700
MHCP PROVIDER NUMBER
MN
Enumeration date
12/20/2006
Last updated
09/10/2009
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