Healthcare Provider Details

I. General information

NPI: 1073755385
Provider Name (Legal Business Name): LAKEVIEW RANCH HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69531 213TH ST
DARWIN MN
55324-6602
US

IV. Provider business mailing address

69531 213TH ST
DARWIN MN
55324-6602
US

V. Phone/Fax

Practice location:
  • Phone: 320-275-4611
  • Fax: 320-275-4030
Mailing address:
  • Phone: 320-275-4611
  • Fax: 320-275-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: MS. JUDY A BERRY
Title or Position: CEO
Credential:
Phone: 320-275-4027