NPIMap

Organization Active NPI

Lakes Region Chemical Dependency LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bemidji, MN
National Provider Identifier
1689874562
Registry record updated Jul 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
1042531 Issued in MN
Legal business name
LAKES REGION CHEMICAL DEPENDENCY LLC
Practice address
1510 Bemidji Ave N Ste 13
Bemidji, MN 56601-3804
Phone
(218) 444-5740
Fax
(218) 333-0241
NPI assigned
Jul 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2007

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

Authorized official

Name
Jessica A Dewey, B.A., LADCNPI 1407819758
Title
Owner/Treatment Director
Phone
(218) 444-5740

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1042531 MN Primary

Addresses

Primary practice location

1510 Bemidji Ave N Ste 13
Bemidji, MN 56601-3804

Mailing address

1510 Bemidji Ave N Ste 13
Bemidji, MN 56601-3804
Phone (218) 444-5740

National Provider Directory

National Provider Directory

Locations

1510 Bemidji Ave N
Ste 13
Bemidji, MN 56601
Phone (218) 444-5740

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1689874562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 BEMIDJI AVE N STE 13",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013804",
            "telephone_number": "218-444-5740",
            "fax_number": "218-333-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 BEMIDJI AVE N STE 13",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013804",
            "telephone_number": "218-444-5740",
            "fax_number": "218-333-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES REGION CHEMICAL DEPENDENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2007-07-19",
        "status": "A",
        "authorized_official_last_name": "DEWEY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/TREATMENT DIRECTOR",
        "authorized_official_telephone_number": "218-444-5740",
        "authorized_official_credential": "B.A., LADC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "1042531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bemidji, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; 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.