Organization
LAKE REGION CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN DAVIDSON (CEO)
(701) 662-8681
Entity
Organization
Contact information
Practice address
923 6TH AVE NE, DEVILS LAKE, ND 58301-2210
(701) 662-8681
(701) 662-5776
Mailing address
224 3RD ST NW, DEVILS LAKE, ND 58301-2908
(701) 662-8681
(701) 662-5776
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30826
PROVIDER NUMBER
ND
Enumeration date
12/28/2006
Last updated
08/22/2020
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