LAKE REGION CORPORATION (NPI# 1871659797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871659797 |
| Entity Type | Organization |
| Organization Name | LAKE REGION CORPORATION |
| Practice Address |
923 6th Ave Ne Devils Lake ND 58301-2210 |
| Mailing Address |
224 3rd St Nw Devils Lake ND 58301-2908 |
| Practice Telephone | 7016628681 |
| Practice Fax Number | 7016625776 |
| Mailing Telephone | 7016628681 |
| Mailing Fax Number | 7016625776 |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ELLEN DAVIDSON (CEO) |
| Authorized Official Telephone | 7016628681 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310500000X | Intermediate Care Facility, Mental Illness | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | PROVIDER NUMBER | 30826 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487251153 | Lake Region Corporation | Community/Behavioral Health | 116 20th St Ne, Devils Lake, ND 58301-1616 | 2020-10-06 |
| 1740887702 | Lake Region Corporation | Community/Behavioral Health | 224 3rd St Nw, Devils Lake, ND 58301-2908 | 2020-10-02 |
| 1790302420 | Lake Region Corporation | Intermediate Care Facility, Mentally Retarded | 2017 Highway 20, Devils Lake, ND 58301-8650 | 2020-06-29 |
| 1689271355 | Lake Region Corporation | Community/Behavioral Health | 224 3rd St Nw, Devils Lake, ND 58301-2908 | 2020-10-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LAKE REGION CORPORATION | 224 3rd St Nw, Devils Lake, ND 58301-2908 |
| Street Address |
923 6TH AVE NE |
| City | DEVILS LAKE |
| State | ND |
| Zip Code | 58301-2210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578187977 | Mark Christian Beatty | Social Worker | 1820 East Walnut Street, Suite 5, Devils Lake, ND 58301 | 2020-06-01 |
| 1841837663 | Wayne Rance | Pharmacist | 323 5th St Ne Ste 2, Devils Lake, ND 58301 | 2019-12-01 |
| 1639427792 | Donna Rance | Pharmacist | Bell Pharmacy 323 5th St Ne, Suite #2, Devils Lake, ND 58301 | 2012-08-21 |
| 1356603997 | Stephanie Ann Foughty | Family Medicine | 1001 7th St Ne Altru Clinic/devlis Lake, Devils Lake, ND 58301 | 2012-06-11 |
| 1245534668 | Altru Specialty Services, Inc. | Durable Medical Equipment & Medical Supplies | 223 4th Avenue Northeast, Suite B, Devils Lake, ND 58301 | 2010-12-28 |
| 1780830208 | Steven L Pederson | Physical Therapist | 404 Fourth Street N, Devils Lake, ND 58301 | 2008-08-15 |
| 1437368768 | Leatha N Vaagen | Physical Therapist | 404 Fourth Street North, Devils Lake, ND 58301 | 2007-05-22 |
| 1770634479 | Becky Fletschock | Pharmacist | Clinic Pharmacy, 1001 7th St Ne, Devils Lake, ND 58301 | 2007-01-16 |
| 1518047570 | The Evangelical Lutheran Good Samaritan Society | Custodial Care Facility | 302 7th Ave, Devils Lake, ND 58301 | 2006-10-16 |
| 1679591929 | Emergency Ambulance of Devils Lake | Ambulance | 314 2nd Ave Se, Devils Lake, ND 58301 | 2006-07-17 |
| Find all providers in zip 58301 | ||||
| Taxonomy Code | 310500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mental Illness |
| A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295869501 | Life Skills and Transition Center Dental | Intermediate Care Facility, Mental Illness | 701 W 6th St, Grafton, ND 58237-1379 | 2007-03-16 |
| City | DEVILS LAKE |
| Zip Code | 58301 |
Please comment or provide details below to improve the information on LAKE REGION CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.