Organization
RAMSEY COUNTY D.B.A. LAKE OWASSO RESIDENCE
Active
Other names
Lake Owasso Residence
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS MICHAEL SPEGGEN MS (ADMINISTRATOR)
(651) 765-7703
Entity
Organization
Contact information
Practice address
210 N OWASSO BLVD, SHOREVIEW, MN 55126-3074
(651) 765-7700
(651) 765-7722
Mailing address
210 N OWASSO BLVD, SHOREVIEW, MN 55126-3074
(651) 765-7700
(651) 765-7722
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
801333-1-RS
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
436843600
—
MN
Enumeration date
12/05/2006
Last updated
06/19/2008
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