MR. JACK LANE IV (NPI# 1275902520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275902520 |
| Entity Type | Individual |
| Full Name | MR. JACK LANE IV |
| Credential | PTA |
| Practice Address |
615 29th St Lewiston ID 83501-3341 |
| Practice Telephone | 2089854722 |
| Mailing Telephone | 2089854722 |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | PTA-3672 | ID | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528037793 | Jack Lane | Family Medicine | 937 Franklin Ave, Lemoore, CA 93246-0001 | 2006-03-17 |
| Street Address |
615 29TH ST |
| City | LEWISTON |
| State | ID |
| Zip Code | 83501-3341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679193759 | Jacqueline M Aldrich | Behavior Technician | 3407 12th Street C, 3407 12th Street C, Lewiston, ID 83501 | 2020-04-20 |
| 1295228054 | Provident Foundation - Wedgewood Terrace LLC | Alzheimer Center (Dementia Center) | 2114 Vineyard Avenue, Lewiston, ID 83501 | 2018-06-07 |
| 1164945325 | Xiaofei Liu | Massage Therapist | 234 Thain Rd, Lewiston, ID 83501 | 2017-07-19 |
| 1467909879 | Sharon Thulon | Registered Nurse | 1118 F Street, Lewiston, ID 83501 | 2016-09-01 |
| 1821459496 | Gem State Endoscopy | Clinic/Center | 3709 14th Street, Lewiston, ID 83501 | 2016-03-10 |
| 1508264995 | Gary L. Grogan | Psychologist | 633 Main Street, B#1, Lewiston, ID 83501 | 2014-12-17 |
| 1003189366 | John Joseph Johnson | Dentist | 3510 12th Street, Suite #600, Lewiston, ID 83501 | 2012-02-17 |
| 1306134077 | Rowena Kathryn Jackson | Counselor | 531 Bryden Avenue, Lewiston, ID 83501 | 2011-07-15 |
| 1912290388 | Staci Leanne Truby | Massage Therapist | 717 'd' Street, Lewiston, ID 83501 | 2011-05-18 |
| 1093040685 | Sharie Ann Uhlorn | Registered Nurse | 1837 Alder Court, Lewiston, ID 83501 | 2009-10-15 |
| Find all providers in zip 83501 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871042663 | Ahc of Lewiston, LLC | Skilled Nursing Facility | 2852 Juniper Dr, Lewiston, ID 83501-4719 | 2016-09-22 |
| 1326193863 | Eagle Healthcare Inc | Skilled Nursing Facility | 1014 Burrell Ave, Lewiston, ID 83501-5472 | 2007-01-24 |
| 1700948122 | Lewiston Operations, LLC | Skilled Nursing Facility | 33 Roger St, Lewiston, ME 04240-3328 | 2006-12-14 |
| 1083637011 | Kindred Nursing Centers West, LLC | Skilled Nursing Facility | 3315 8th St, Lewiston, ID 83501-4966 | 2006-07-25 |
| 1235182155 | Clearwater Operations, LLC | Skilled Nursing Facility | 325 Warner Dr, Lewiston, ID 83501-4437 | 2006-05-19 |
| 1255322087 | Royal Plaza Retirement Center Lewiston, LLC | Skilled Nursing Facility | 2870 Juniper Dr, Lewiston, ID 83501-4720 | 2005-11-01 |
| 1679562011 | Division of Veterans Services | Skilled Nursing Facility | 821 21st Ave, Lewiston, ID 83501-6389 | 2005-10-18 |
| 1528054657 | Fairchild Manor Nursing Home LLC | Skilled Nursing Facility | 765 Fairchild Pl, Lewiston, NY 14092-1309 | 2005-09-23 |
| 1720073539 | Our Lady of Peace Inc. | Skilled Nursing Facility | 5285 Lewiston Rd, Lewiston, NY 14092-1942 | 2005-09-19 |
| 1952306524 | St. Mary's Regional Medical Center | Skilled Nursing Facility | 102 Campus Ave, Lewiston, ME 04240-6019 | 2005-06-20 |
| Find all providers in LEWISTON | ||||
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| 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.