1013910439 NPI number — LAKELAND HOSPICE, INC.

Table of content: (NPI 1013910439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013910439 NPI number — LAKELAND HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKELAND HOSPICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013910439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 PEBBLE LAKE RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-3858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-998-1400
Provider Business Mailing Address Fax Number:
218-998-1420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 PEBBLE LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-998-1400
Provider Business Practice Location Address Fax Number:
218-998-1420
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PELACCIO
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
218-998-1400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  333772 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 333817 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6J75LA . This is a "HOME CARE BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 50-25406 . This is a "HOSPICE MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 737565400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59-00133 . This is a "HOME CARE MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 777223800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2Z97LA . This is a "HOSPICE BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com