Provider Demographics
NPI:1316147523
Name:LAKEWOOD HEALTH SYSTEM
Entity type:Organization
Organization Name:LAKEWOOD HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOLHOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-894-8600
Mailing Address - Street 1:401 PRAIRIE AVE NE
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-3201
Mailing Address - Country:US
Mailing Address - Phone:218-894-1515
Mailing Address - Fax:218-898-7596
Practice Address - Street 1:401 PRAIRIE AVE NE
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-3201
Practice Address - Country:US
Practice Address - Phone:218-894-1515
Practice Address - Fax:218-898-7596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEWOOD HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24M329Medicare Oscar/Certification