WALLOON LAKE RECOVERY LODGE, LLC (NPI# 1861898918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861898918 |
| Entity Type | Organization |
| Organization Name | WALLOON LAKE RECOVERY LODGE, LLC |
| Practice Address |
2594 Springvale Rd Boyne Falls MI 49713 |
| Mailing Address |
2594 Springvale Road Boyne Falls MI 49713 |
| Practice Telephone | 2315352415 |
| Mailing Telephone | 2315352415 |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2014-11-17 |
| Authorized Official Name | MR. MARTIN J GITRE (MEMBER) |
| Authorized Official Telephone | 2487630863 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | L183579 | MI | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750791505 | Walloon Lake Recovery Lodge, LLC | Counselor | 811 Sammons St, Cheboygan, MI 49721 | 2014-05-02 |
| Street Address |
2594 SPRINGVALE RD |
| City | BOYNE FALLS |
| State | MI |
| Zip Code | 49713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235478363 | Bear River Health | Substance Abuse Rehabilitation Facility | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2013-02-08 |
| 1023629201 | Lindsay Ann Walker | Counselor | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2020-08-12 |
| 1811522550 | Gretchen Fontichiaro | Counselor | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2020-03-03 |
| 1760015077 | Jennifer Martin | Counselor | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2020-02-14 |
| 1740813278 | Barbara Morgan | Counselor | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2020-02-12 |
| 1750940482 | Jamie Erin Love | Counselor | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2019-06-06 |
| 1093372427 | Genevieve Carol Groover | Social Worker | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2019-05-21 |
| 1700376217 | Elizabeth Mcgann | Social Worker | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2018-05-10 |
| 1578051322 | Heather Diggs | Psychologist | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2018-04-27 |
| 1043765662 | Alisha Peck | Substance Abuse Rehabilitation Facility | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2016-08-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144454612 | Sally L Wagle | Registered Nurse | 7735 Chandler Hill Rd, Boyne Falls, MI 49713 | 2009-05-12 |
| 1437188711 | Boyne Valley Township | Ambulance | 2286 Railroad St., Boyne Falls, MI 49713 | 2006-06-30 |
| 1386977395 | Carrie Kristine Saunders | Occupational Therapist | 5293 Gokee Rd, Boyne Falls, MI 49713-9307 | 2009-09-09 |
| 1336425610 | Ann Teresa Holland | Counselor | 3415 Hill Vw, Boyne Falls, MI 49713-9668 | 2011-10-31 |
| 1801421912 | Reilly Philliben | Student in an Organized Health Care Education/Training Program | 2434 Us Highway 131 S, Boyne Falls, MI 49713-9767 | 2020-03-09 |
| 1750980736 | Lucas Mccarry | Behavior Technician | 1821 Valley View Rd, Boyne Falls, MI 49713-9794 | 2020-10-21 |
| 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 |
|---|---|---|---|---|
| 1235478363 | Bear River Health | Substance Abuse Rehabilitation Facility | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2013-02-08 |
| 1043765662 | Alisha Peck | Substance Abuse Rehabilitation Facility | 2594 Springvale Rd, Boyne Falls, MI 49713-9684 | 2016-08-24 |
| 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 | ||||
| City | BOYNE FALLS |
| Zip Code | 49713 |
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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.