1. Home
  2. Directory
  3. Minnesota
  4. Mahtomedi
  5. Substance Abuse Rehabilitation Facility
  6. NPI Profile

LAKE SHORE TREATEMENT CENTER LLC
NPI 1023430519
Substance Abuse Rehabilitation Facility in Mahtomedi, MN

Active since January 17, 2014CLIA 24D2073190 · Waiver
140 QUAIL ST, MAHTOMEDI, MN 55115(612) 326-7600 Get Directions Write a Review

NPPES record last updated: February 20, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lake Shore Treatement Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE SHORE TREATEMENT CENTER LLC (NPI 1023430519), doing business as Eosis Lakeshore, is a healthcare organization registered as a substance abuse rehabilitation facility in Mahtomedi, Minnesota and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through February 11, 2028 and lists Lewis P Zeidner, Ceo, as its authorized official.

NPPES Registry Identity

NPI1023430519
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameLAKE SHORE TREATEMENT CENTER LLC
Location Address140 QUAIL STMahtomedi, MN 55115-1941
Mailing Address550 Main St Ste 230New Brighton, MN 55112-3274 · (612) 326-7600 · Fax (651) 631-3231
Phone(612) 326-7600
Organization SubpartNo
Authorized OfficialLewis P ZeidnerCeo · (763) 245-8278
Enumeration DateJanuary 17, 2014
Last NPPES UpdateFebruary 20, 2025
✔ NPI 1023430519 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
License✔ Licensed in MN · 1067244
Definition
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.
140 QUAIL ST, Mahtomedi, MN 55115
Open in Google Maps ↗

Other Names 1

Doing Business AsEosis Lakeshore

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2073190

Lakeshore Dba Lake Shore · Mahtomedi, MN
Active · expires Feb 11, 2028
CLIA Number24D2073190
Laboratory TypeSub Treatment Facility
Certificate Effective DateFebruary 12, 2026
Certificate Expiration DateFebruary 11, 2028
Laboratory DirectorEmily Brunner
Laboratory Phone(612) 454-5000
Laboratory LocationLakeshore Dba Lake Shore140 Quail Street, Mahtomedi, MN 55115
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHARLA MAY WOODS
Counselor (Addiction (Substance Use Disorder))
140 QUAIL ST
MAHTOMEDI, MN 55115
Washington County (952) 843-4113
JEAN MARIE PLATTNER LADC
Counselor (Addiction (Substance Use Disorder))
140 QUAIL ST
MAHTOMEDI, MN 55115
Washington County (612) 454-2469
MR. STEVE DONALD HERRICK LADC
Counselor (Addiction (Substance Use Disorder))
140 QUAIL ST
MAHTOMEDI, MN 55115
Washington County (612) 454-2468

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Shore Treatement Center LLC's NPI number?

The NPI number for Lake Shore Treatement Center LLC is 1023430519. It was assigned to this organization in the NPPES registry on January 17, 2014. The provider is doing business as Eosis Lakeshore.

Where is Lake Shore Treatement Center LLC located?

Lake Shore Treatement Center LLC is located at 140 Quail St, Mahtomedi, MN 55115. The listed phone number is (612) 326-7600.

What is Lake Shore Treatement Center LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Lake Shore Treatement Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2073190) is associated with this NPI, valid through February 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lake Shore Treatement Center LLC accept?

Health plans from HealthPartners list Lake Shore Treatement Center LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lake Shore Treatement Center LLC was last updated on February 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.