WALLOON LAKE RECOVERY LODGE, LLC (NPI# 1750791505) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750791505 |
| Entity Type | Organization |
| Organization Name | WALLOON LAKE RECOVERY LODGE, LLC |
| Other Organization Name | BEAR RIVER HEALTH |
| Practice Address |
811 Sammons St Cheboygan MI 49721 |
| Mailing Address |
2329 Center St Boyne Falls MI 49713-9268 |
| Practice Telephone | 2315352822 |
| Mailing Telephone | 2315352822 |
| Mailing Fax Number | 2315352372 |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2020-11-05 |
| Authorized Official Name | JACKIE DEE WURST (FINANCIAL DIRECTOR) |
| Authorized Official Telephone | 2317584566 |
| Authorized Official Credential | RMA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities | ||
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | LARA LICENSE | SA0240041 | 01 |
| MI | LARA LICENSE | SA0150024 | 01 |
| MI | LARA LICENSE | SA0690033 | 01 |
| MI | LARA LICENSE | SA0150031 | 01 |
| Other Name | Type Code |
|---|---|
| Bear River Health | Doing Business As Name - Organization |
| Bear River Outreach | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1619 West M32, Gaylord, MI 49735 | 2315352822 | |
| 218 Water St, Cheboygan, MI 497211606 | 2317510070 | |
| 2329 Center St, Boyne Falls, MI 497139268 | 2315352822 | 2315352372 |
| 2594 Springvale Rd, Boyne Falls, MI 49713 | 2315352822 | 2315352372 |
| 541 E Main St, Gaylord, MI 497351343 | 2315352822 | |
| 829 W Main St Ste G, Gaylord, MI 497351998 | 2315352822 | |
| 8484 M 119, Harbor Springs, MI 497409515 | 2315359200 | |
| 8486 M 119, Harbor Springs, MI 497408508 | 2315454141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861898918 | Walloon Lake Recovery Lodge, LLC | Substance Abuse Rehabilitation Facility | 2594 Springvale Rd, Boyne Falls, MI 49713 | 2014-11-17 |
| Street Address |
811 SAMMONS ST |
| City | CHEBOYGAN |
| State | MI |
| Zip Code | 49721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124505755 | Cheboygan Area High School - Counseling Room | Clinic/Center | 801 W Lincoln Ave, Cheboygan, MI 49721 | 2018-07-26 |
| 1073048542 | Emily K Stevens | Counselor | 520 North Main St., Suite 202, Cheboygan, MI 49721 | 2017-04-21 |
| 1093102311 | Ashley Richards | Physical Therapy Assistant | 428 S. Huron St., Cheboygan, MI 49721 | 2015-04-24 |
| 1891118535 | Bethanie Norton-boss | Occupational Therapist | 4016 W. Us23, Cheboygan, MI 49721 | 2014-01-31 |
| 1457780751 | Alicia Yokom | Physical Therapist | 12550 Goebel Road, Cheboygan, MI 49721 | 2013-11-06 |
| 1902121049 | Shellie Charboneau | Massage Therapist | 321 S. Huron, Cheboygan, MI 49721 | 2010-04-01 |
| 1215269287 | Bay Street Orthopaedics Pllc | Orthopaedic Surgery | 838 South Main, Cheboygan, MI 49721 | 2010-02-02 |
| 1598099137 | Vitalcare Home Medical Equipment Inc | Durable Medical Equipment & Medical Supplies | 602 W. Seymour Street, Cheboygan, MI 49721 | 2009-09-30 |
| 1922243138 | Sarah B. Proctor | Acupuncturist | 520 N. Main St, Suite 303, Cheboygan, MI 49721 | 2008-12-03 |
| 1417145046 | Janice Seccia | Pharmacist | 748 S. Main St, Mclaren Northern Mi - Cheboygan Campus, Cheboygan, MI 49721 | 2007-10-09 |
| Find all providers in zip 49721 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063810 | Nc Recovery House LLC | Substance Abuse Rehabilitation Facility | 777 Colfax Ave, Benton Harbor, MI 49022-7406 | 2020-05-06 |
| 1235789074 | Green Castle Recovery Centers, LLC. | Substance Abuse Rehabilitation Facility | 233 Fulton St E Ste 101, Grand Rapids, MI 49503-3262 | 2019-09-13 |
| 1043773047 | New Paths, Inc. | Substance Abuse Rehabilitation Facility | 909 Martin Luther King Ave, Flint, MI 48503-1488 | 2019-04-08 |
| 1831651330 | Bethany House Recovery House | Substance Abuse Rehabilitation Facility | 722 S Rose St, Kalamazoo, MI 49007-5216 | 2019-04-03 |
| 1639631138 | Hope House Recovery House | Substance Abuse Rehabilitation Facility | 131 S Nottawa St, Sturgis, MI 49091-1736 | 2019-04-03 |
| 1811459324 | Healing House | Substance Abuse Rehabilitation Facility | 721 S Rose St Apt B, Kalamazoo, MI 49007-6200 | 2019-04-03 |
| 1669932109 | Inner Man Wellness and Support Services | Substance Abuse Rehabilitation Facility | 4890 Ballantrae Rd, Bloomfield, MI 48301-1000 | 2019-03-21 |
| 1528526266 | Mid-michigan Recovery Center | Substance Abuse Rehabilitation Facility | 3821 N Grant Ave, Harrison, MI 48625-9606 | 2019-03-12 |
| 1316410681 | The Light Treatment & Rehabilitation LLC | Substance Abuse Rehabilitation Facility | 5380 Kreger St, Sterling Heights, MI 48310-5728 | 2019-01-09 |
| 1306321179 | Yarrow Lodge, LLC | Substance Abuse Rehabilitation Facility | 10677 N 48th Street, Augusta, MI 49012 | 2018-09-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.