Active NPI
Lake Country Associates, Inc.
- Community/Behavioral Health Agency
- Park Rapids, MN
National Provider Identifier
1104151588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- LAKE COUNTRY ASSOCIATES, INC.
- Practice address
- 515 Bridge St
Park Rapids, MN 56470-1210 - Phone
- (218) 366-9229
- NPI assigned
- Oct 2, 2009
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Mrs. Jean Kirchner, MSW, LICSW
- Title
- Ceo
- Phone
- (218) 366-9229
Practitioners 88
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records 1
Medicare enrollment files| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100429000429 | MN | Part B Supplier - Clinic/Group Practice | 3779610472 |
Receives reassigned benefits from 15 practitioners Practice locations: Park Rapids, MN |
National Provider Directory
National Provider DirectoryLocations
615 Anne St NW
Bemidji, MN 56601
11 Main St NW
Menahga, MN 56464
515 Bridge St
Park Rapids, MN 56470
Phone (218) 252-0066
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
515 Bridge St
Park Rapids, MN 56470-1210
Mailing address
515 Bridge St
Park Rapids, MN 56470-1210
Phone (218) 366-9229
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 28, 2017.
{
"created_epoch": "1254441600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1488240000000",
"number": "1104151588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 BRIDGE ST",
"city": "PARK RAPIDS",
"state": "MN",
"postal_code": "564701210",
"telephone_number": "218-366-9229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 BRIDGE ST",
"city": "PARK RAPIDS",
"state": "MN",
"postal_code": "564701210",
"telephone_number": "218-366-9229"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE COUNTRY ASSOCIATES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2009-10-02",
"last_updated": "2017-02-28",
"status": "A",
"authorized_official_last_name": "KIRCHNER",
"authorized_official_first_name": "JEAN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "218-366-9229",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "MSW, LICSW"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.