Provider Demographics
NPI:1083048128
Name:LAKELAND HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:LAKELAND HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-354-7648
Mailing Address - Street 1:10600 OLD COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6200
Mailing Address - Country:US
Mailing Address - Phone:763-354-7647
Mailing Address - Fax:
Practice Address - Street 1:11855 ULYSSES ST NE STE 210
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4181
Practice Address - Country:US
Practice Address - Phone:763-576-9068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54836173F00000X
332B00000X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies