Healthcare Provider Details

I. General information

NPI: 1043205917
Provider Name (Legal Business Name): LSS HOME HEALTH AND HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SHADY LANE DR
WADENA MN
56482-3093
US

IV. Provider business mailing address

201 SHADY LANE DR
WADENA MN
56482-3093
US

V. Phone/Fax

Practice location:
  • Phone: 218-632-1335
  • Fax: 218-632-1336
Mailing address:
  • Phone: 218-632-1335
  • Fax: 218-632-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number357793
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number357794
License Number StateMN

VIII. Authorized Official

Name: MR. ERIC R. LUNDE
Title or Position: PRESIDENT
Credential:
Phone: 218-631-1391