NPIMap

Organization Active NPI

Maple Lake Recovery Center, Inc.

  • Children's Substance Abuse Rehabilitation Facility
  • Maple Lake, MN
National Provider Identifier
1760587109
Registry record updated Sep 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
License
810975-1-CRF Issued in MN
Legal business name
MAPLE LAKE RECOVERY CENTER, INC.
Practice address
207 Division St. E
Maple Lake, MN 55358
Phone
(320) 963-6865
Fax
(320) 963-6279
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2008

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

Authorized official

Name
Judith M Feenstra, LADC
Title
Administrator
Phone
(612) 501-1197

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Substance Abuse Rehabilitation Facility 3245S0500X 810975-1-CRF MN Primary

Addresses

Primary practice location

207 Division St. E
Maple Lake, MN 55358

Mailing address

P O Box 308
207 Division St. E
Maple Lake, MN 55358
Phone (320) 963-6865

National Provider Directory

National Provider Directory
Tax ID family
Dimensions in Recovery II3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220400000000",
    "number": "1760587109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 308",
            "address_2": "207 DIVISION ST. E",
            "city": "MAPLE LAKE",
            "state": "MN",
            "postal_code": "55358",
            "telephone_number": "320-963-6865",
            "fax_number": "320-963-6279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 DIVISION ST. E",
            "city": "MAPLE LAKE",
            "state": "MN",
            "postal_code": "55358",
            "telephone_number": "320-963-6865",
            "fax_number": "320-963-6279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE LAKE RECOVERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2008-09-03",
        "status": "A",
        "authorized_official_last_name": "FEENSTRA",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "612-501-1197",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "MN",
            "license": "810975-1-CRF",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; 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.