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General NPI Number Information
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NPI Number | 1245328707
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Entity Type | Organization
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Legal Business Name | LAKE VIEW MEMORIAL HOSPITAL, INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 325 11TH AVE
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City | TWO HARBORS
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State | MN
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Zip | 55616-1300
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Country | US
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Telephone | 218-834-7300
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Fax | 218-834-7388
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Provider Business Mailing Address
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Address Line | 325 11TH AVE
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City | TWO HARBORS
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State | MN
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Zip | 55616-1300
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Country | US
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Telephone | 218-834-7300
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Fax | 218-834-7388
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Authorized Official
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Title or Position | SVP & CHIEF FINANCIAL OFFICER
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Name | JERRY YANG
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Credential |
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Telephone | 715-847-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 331064
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License Number State | MN
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