Lakes Opioid Treatment Program, Inc
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Walker, MN
NPI 1104374073 · NPPES record last updated Oct 10, 2016
Key facts
- NPI
- 1104374073
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- LAKES OPIOID TREATMENT PROGRAM, INC
- Practice address
- 8381 Lake Land TRL NW
Walker, MN 56484-2109 - Phone
- (763) 412-9441
- NPI assigned
- Sep 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Stephanie Dawn Losh
- Title
- Co-Owner
- Phone
- (612) 877-2465
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
8381 Lake Land TRL NW
Walker, MN 56484-2109
Mailing address
15477 Sodium St NW
Ramsey, MN 55303-5415
Phone (763) 412-9441
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All providers in Walker, MN · Substance Use Disorder Rehabilitation Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.