| Lake Superior Treatment Center | |
|
14 E Central Entrance Suite B Duluth MN 55811-5508 | |
| (218) 786-0223 | |
| (218) 786-0226 |
| Full Name | Lake Superior Treatment Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 14 E Central Entrance, Duluth, Minnesota |
| Authorized Official Name and Position | Patrick John Chunn (CFO) |
| Authorized Official Contact | 4073517080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Superior Treatment Center 14050 Town Loop Blvd Suite 204 Orlando FL 32837-6190 Ph: (407) 351-7080 | Lake Superior Treatment Center 14 E Central Entrance Suite B Duluth MN 55811-5508 Ph: (218) 786-0223 |
| NPI Number | 1902012107 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 11/22/2021 |
| Certification Date | 11/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902012107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1008733-1-CDT (Minnesota) | Primary |
| 3336C0002X | Pharmacy - Clinic Pharmacy | 261964-8 (Minnesota) | Secondary |
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