NPIMap

Organization Active NPI

Lake Region Corporation

  • Mental Illness Intermediate Care Facility
  • Devils Lake, ND
National Provider Identifier
1871659797
Registry record updated Aug 22, 2020
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Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
Legal business name
LAKE REGION CORPORATION
Practice address
923 6TH Ave NE
Devils Lake, ND 58301-2210
Phone
(701) 662-8681
Fax
(701) 662-5776
NPI assigned
Dec 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ellen Davidson
Title
Ceo
Phone
(701) 662-8681

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X Primary

Addresses

Primary practice location

923 6TH Ave NE
Devils Lake, ND 58301-2210

Mailing address

224 3Rd St NW
Devils Lake, ND 58301-2908
Phone (701) 662-8681

Other identifiers 1

IdentifierTypeStateIssuer
30826OtherNDPROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 35G074

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LAKE REGION CORPORATION-923
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 18, 1989
Last certification
Feb 19, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
923 6TH Ave NE
Devils Lake, ND 58301

National Provider Directory

National Provider Directory
Tax ID family
Lake Region Corporation6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871659797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 3RD ST NW",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012908",
            "telephone_number": "701-662-8681",
            "fax_number": "701-662-5776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 6TH AVE NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012210",
            "telephone_number": "701-662-8681",
            "fax_number": "701-662-5776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGION CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-662-8681"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "30826",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Devils Lake, ND

Sources for this page

Verify at the official NPI Registry.