Healthcare Provider Details

I. General information

NPI: 1972566875
Provider Name (Legal Business Name): LAKES REGIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 21ST STREET
MILFORD IA
51351
US

IV. Provider business mailing address

1003 21ST STREET
MILFORD IA
51351
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-9998
  • Fax: 712-338-9990
Mailing address:
  • Phone: 712-338-9998
  • Fax: 712-338-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number300028H
License Number StateIA

VIII. Authorized Official

Name: MR. STEVEN J ALGER
Title or Position: SR VP AND CFO
Credential:
Phone: 712-336-8796