LAKE REGION LUTHERAN HOME, INC. (NPI# 1619536976) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619536976 |
| Entity Type | Organization |
| Organization Name | LAKE REGION LUTHERAN HOME, INC. |
| Practice Address |
1332 10th St Ne Devils Lake ND 58301-2329 |
| Mailing Address |
801 Main Ave Ste 201 Moorhead MN 56560-2871 |
| Practice Telephone | 7016621880 |
| Practice Fax Number | 7016621084 |
| Mailing Telephone | 2182912216 |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | JON RIEWER (PRESIDENT & CEO) |
| Authorized Official Telephone | 2182912201 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Eventide Lake Country Manor Basic Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689667834 | Lake Region Lutheran Home, Inc. | Nursing Facility/Intermediate Care Facility | 620 14th Ave Ne, Devils Lake, ND 58301-2808 | 2005-08-23 |
| 1457910713 | Lake Region Lutheran Home, Inc. | Skilled Nursing Facility | 302 7th Ave Ne, Devils Lake, ND 58301-2516 | 2019-06-11 |
| Street Address |
1332 10TH ST NE |
| City | DEVILS LAKE |
| State | ND |
| Zip Code | 58301-2329 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689942609 | The Evangelical Lutheran Good Samaritan Society | Custodial Care Facility | 1332 10th St Ne, Devils Lake, ND 58301-2329 | 2011-12-05 |
| 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 | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669072294 | Wp-arc Minot Holdings, LLC | Assisted Living Facility | 601 24th Ave Sw, Minot, ND 58701-7099 | 2020-11-01 |
| 1285231407 | Unsong Ringuette | Assisted Living Facility | 1608 16th St Nw, Minot, ND 58703-1114 | 2020-10-01 |
| 1295342822 | Park View Manor LLC | Assisted Living Facility | 618 8th Ave Ne, Rolla, ND 58367-7345 | 2020-09-28 |
| 1083239776 | Altru Health System | Assisted Living Facility | 4004 24th Ave S, Grand Forks, ND 58201-8863 | 2020-06-09 |
| 1437621885 | Edgewood Minot Senior Living, LLC | Assisted Living Facility | 520 28th Ave, Minot, ND 58208 | 2018-12-26 |
| 1891241139 | Edgewood Jamestown,llc | Assisted Living Facility | 322 Demers Ave, Suite 500, Grand Forks, ND 58201-4754 | 2016-08-28 |
| 1013386788 | Ecumen | Assisted Living Facility | 1405 W Gateway Cir S, Fargo, ND 58103-3529 | 2015-09-23 |
| 1306243647 | Edgewood Mandan, LLC | Assisted Living Facility | 2801 39th Ave Se, Mandan, ND 58554-6430 | 2014-12-02 |
| 1225437460 | New Town Health Support Corporation | Assisted Living Facility | 603 1st Street Nw, New Town, ND 58763 | 2014-08-13 |
| 1639501141 | Lakewood Landing, Inc. | Assisted Living Facility | 4401 21st St Se, Mandan, ND 58554 | 2013-08-07 |
| Find all providers with the same taxonomy | ||||
| City | DEVILS LAKE |
| Zip Code | 58301 |
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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.