Healthcare Provider Details

I. General information

NPI: 1801016027
Provider Name (Legal Business Name): LAKES HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 LAKE ST
SPIRIT LAKE IA
51360-1100
US

IV. Provider business mailing address

1703 W 5TH ST STE 800
AUSTIN TX
78703-4893
US

V. Phone/Fax

Practice location:
  • Phone: 712-336-2941
  • Fax: 712-336-2591
Mailing address:
  • Phone: 512-634-4900
  • Fax: 512-634-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEW N LITTLE JR.
Title or Position: CEO
Credential:
Phone: 512-634-4900