Healthcare Provider Details

I. General information

NPI: 1356342851
Provider Name (Legal Business Name): LAKE ANDES HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E LAKE ST
LAKE ANDES SD
57356-2001
US

IV. Provider business mailing address

740 E LAKE ST PO BOX 216
LAKE ANDES SD
57356-2001
US

V. Phone/Fax

Practice location:
  • Phone: 605-487-7674
  • Fax: 605-487-7071
Mailing address:
  • Phone: 605-487-7674
  • Fax: 605-487-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10638
License Number StateSD

VIII. Authorized Official

Name: MRS. PAM J WELLS
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-487-7674