NPI 1679750426

Prairie Lakes Youth Programs Boys Group Home

Organisation Children's Substance Abuse Rehabilitation Facility Willmar, MN

Practice location

Address: 1013 Lakeland Dr NE, Willmar, MN 56201-2114
Phone: (320) 235-6895
Fax: (320) 231-3818
Mailing address: 1804 Civic Center Dr PO Box 902, Willmar, MN 56201-9446

Authorised official

Name: Joyce K. McGillivray
Title: Accounts Manager
Phone: (320) 235-0975

Registered specialties

Children's Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 3245S0500X Licence 1049804-1-CRF (MN)

Other Substance Abuse Rehabilitation Facility providers in Minnesota →

Registry record

NPI: 1679750426
Entity type: Organization
NPI issued: 23 Jan 2008
Record last updated: 23 Jan 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.