Organization
LAKE REGION HALFWAY HOMES, INC.
Active
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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