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LAKE OWASSO RESIDENCE
NPI 1871651521
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Shoreview, MN

Active since December 05, 2006CLIA 24D1059187 · Waiver
210 N OWASSO BLVD, SHOREVIEW, MN 55126(651) 765-7700(651) 765-7722 Get Directions Write a Review

NPPES record last updated: June 19, 2008. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Lake Owasso Residence NPPES

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

LAKE OWASSO RESIDENCE (NPI 1871651521) is a healthcare organization registered as a residential treatment facility, intellectual and/or developmental disabilities in Shoreview, Minnesota and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through September 24, 2026 and lists Louis Michael Speggen, Administrator, as its authorized official.

NPPES Registry Identity

NPI1871651521
Entity TypeOrganization
Primary Taxonomy320600000X
Legal Business NameRAMSEY COUNTY D.B.A. LAKE OWASSO RESIDENCE
Location Address210 N OWASSO BLVDShoreview, MN 55126-3074
Mailing Address210 N Owasso BlvdShoreview, MN 55126-3074 · (651) 765-7700 · Fax (651) 765-7722
Phone(651) 765-7700
Fax(651) 765-7722
Organization SubpartNo
Authorized OfficialLouis Michael SpeggenAdministrator · (651) 765-7703
Enumeration DateDecember 5, 2006
Last NPPES UpdateJune 19, 2008
✔ NPI 1871651521 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320600000X
License✔ Licensed in MN · 801333-1-RS
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
210 N OWASSO BLVD, Shoreview, MN 55126
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Other Names 1

Doing Business AsLake Owasso Residence

Other Identifiers 1

Medicaid436843600MN

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 24D1059187

Lake Owasso Residence · Shoreview, MN
Active · expires Sep 24, 2026
CLIA Number24D1059187
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateSeptember 25, 2024
Certificate Expiration DateSeptember 24, 2026
Laboratory DirectorEdward K. Barry
Laboratory Phone(651) 266-0717
Laboratory LocationLake Owasso Residence210 North Owasso Blvd, Shoreview, MN 55126
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Ramsey County D.B.A. Lake Owasso Residence's NPI number?

The NPI number for Ramsey County D.B.A. Lake Owasso Residence is 1871651521. It was assigned to this organization in the NPPES registry on December 5, 2006. The provider is doing business as Lake Owasso Residence.

Where is Ramsey County D.B.A. Lake Owasso Residence located?

Ramsey County D.B.A. Lake Owasso Residence is located at 210 N Owasso Blvd, Shoreview, MN 55126. The listed phone number is (651) 765-7700.

What is Ramsey County D.B.A. Lake Owasso Residence's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

Does Ramsey County D.B.A. Lake Owasso Residence hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1059187) is associated with this NPI, valid through September 24, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ramsey County D.B.A. Lake Owasso Residence was last updated on June 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years 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.