Provider Demographics
NPI:1538053129
Name:LAKE REGION HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:LAKE REGION HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR-AMBULATORY SERV.
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:507-779-6063
Mailing Address - Street 1:3200 LABORE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5186
Mailing Address - Country:US
Mailing Address - Phone:651-431-5995
Mailing Address - Fax:651-431-7505
Practice Address - Street 1:712 CASCADE ST. S.
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537
Practice Address - Country:US
Practice Address - Phone:800-439-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN CITIES CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-06
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital