Healthcare Provider Details

I. General information

NPI: 1063834778
Provider Name (Legal Business Name): LAKE REGION HOME MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 W LINCOLN AVE
FERGUS FALLS MN
56537-1032
US

IV. Provider business mailing address

2730 NEVADA AVE N
NEW HOPE MN
55427-2807
US

V. Phone/Fax

Practice location:
  • Phone: 320-263-1349
  • Fax:
Mailing address:
  • Phone: 637-535-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SEAN STEINHAUSER
Title or Position: DIRECTOR OF BILLING & COMPLIANCE
Credential:
Phone: 763-442-9677