NPIMap

Organization Active NPI

Lake Country Associates, Inc.

  • Community/Behavioral Health Agency
  • Park Rapids, MN
National Provider Identifier
1104151588
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
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
Last updated
Feb 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
Mrs. Jean Kirchner, MSW, LICSW
Title
Ceo
Phone
(218) 366-9229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

515 Bridge St
Park Rapids, MN 56470-1210

Mailing address

515 Bridge St
Park Rapids, MN 56470-1210
Phone (218) 366-9229

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 88

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 88

NPI Registry JSON

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

{
    "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.

Verify at the official NPI Registry.