Pear Lake Women's Facility - Outpatient

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

10026213CDT Issued in MN

Legal business name

PEAR LAKE WOMEN'S FACILITY - OUTPATIENT

Practice address

2086 Ridgeway Dr
Grand Rapids, MN 55744-4421

Phone

(218) 327-9944

Fax

(218) 327-9944

NPI assigned

May 27, 2010

Organization subpart

Yes

Parent organization

HOPE HOUSE OF ITASCA COUNTY, INC.As reported in NPPES

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

Authorized official

Name

Arika Stanley

Title

Supervisor

Phone

(218) 327-9944

Specialties & licenses 1

Addresses

Tax ID family

Hope House of Itasca County Inc3 organizations share this tax ID, including this one

Part of

Hope House of Itasca County Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Hope House of Itasca County, Inc.

  dba Pear Lake Women's Facility

  • Substance Abuse Rehabilitation Facility
  • Grand Rapids, MN
  • NPI 1851496368
  NPD tax ID
• Hope House of Itasca County, Inc.

  • Substance Abuse Rehabilitation Facility
  • Grand Rapids, MN
  • NPI 1962509364
  NPD tax ID

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617062400000",
    "number": "1225357437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2086 RIDGEWAY DR",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444421",
            "telephone_number": "218-327-9944",
            "fax_number": "218-327-9944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2086 RIDGEWAY DR",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444421",
            "telephone_number": "218-327-9944",
            "fax_number": "218-327-9944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAR LAKE WOMEN'S FACILITY - OUTPATIENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOPE HOUSE OF ITASCA COUNTY, INC.",
        "enumeration_date": "2010-05-27",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "ARIKA",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "218-327-9944"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "10026213CDT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Barry J Pederson, DPT CSCS
• Shara D. Pehl, MD
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• Lindsey Peratalo, PMHNP

• Addiction (Substance Use Disorder) Counselor in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.