| NPI | 1902012107 |
|---|---|
| Doing Business As | LAKE SUPERIOR TREATMENT CENTER |
| Entity Type | Organization |
| Authorized Contact | PATRICK JOHN CHUNN CFO 407-351-7080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN 1008733-1-CDT) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: MN 261964-8) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-11-22 |