Maple Lke Recovery Center Inc

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

License

1032184-1-CRF Issued in MN

Legal business name

MAPLE LKE RECOVERY CENTER INC

Doing business as

Prairie House Recovery

Practice address

305 Prairie Rd
Monticello, MN 55362-8990

Phone

(651) 785-5647

Fax

(763) 295-9579

NPI assigned

Sep 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Judith M Feenstra, BS LADC

Title

Administrator

Phone

(612) 501-1197

Specialties & licenses 1

Addresses

Other names 1

• Prairie House Recovery Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216080000000",
    "number": "1093814576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 DIVISION ST. E.",
            "address_2": "BOX 308",
            "city": "MAPLE LAKE",
            "state": "MN",
            "postal_code": "55358",
            "telephone_number": "320-963-6865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 PRAIRIE RD",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628990",
            "telephone_number": "651-785-5647",
            "fax_number": "763-295-9579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE LKE RECOVERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-07-15",
        "status": "A",
        "authorized_official_last_name": "FEENSTRA",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "612-501-1197",
        "authorized_official_credential": "BS LADC"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "MN",
            "license": "1032184-1-CRF",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie House Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara Macek
• Alan L Mackereth, RPH
• Connor Mahoney
• Deborah L Mahoney, MD
• Joseph Mahoney, MD
• Mark C. Engasser MD PA
• Ellie Marty
• Christine Elizabeth Mason, PSYD, LP
• Kathleen Rose-Penkala Massmann, LPCC AND M,S.
• Brianna Kellee Mattis

• Children's Substance Abuse Rehabilitation Facility in Monticello, MN
• Providers in Monticello, MN by specialty
• Children's Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.