Provider Demographics
NPI:1992262794
Name:LAKELAND RECOVERY, LLC
Entity type:Organization
Organization Name:LAKELAND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-280-1012
Mailing Address - Street 1:3306 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2345
Mailing Address - Country:US
Mailing Address - Phone:612-280-1012
Mailing Address - Fax:
Practice Address - Street 1:3427 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-1221
Practice Address - Country:US
Practice Address - Phone:612-788-9757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children