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General NPI Number Information
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NPI Number | 1982514592
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Entity Type | Organization
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Legal Business Name | LAKE CITY CENTER, INC.
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 1916 N LAKEWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2633
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Country | US
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Telephone | 208-667-4628
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Fax | 208-667-6695
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Provider Business Mailing Address
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Address Line | 1916 N LAKEWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2633
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Country | US
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Telephone | 208-667-4628
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Fax | 208-667-6695
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. VARUNEE PHILLIPS
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Credential |
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Telephone | 208-667-4628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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