Provider Demographics
NPI:1871040485
Name:AUBURN LAKE ACADEMY CORPORATION
Entity type:Organization
Organization Name:AUBURN LAKE ACADEMY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-559-8770
Mailing Address - Street 1:7600 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-9792
Mailing Address - Country:US
Mailing Address - Phone:715-559-8770
Mailing Address - Fax:
Practice Address - Street 1:7600 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-9792
Practice Address - Country:US
Practice Address - Phone:715-559-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness