Organization
LSS OF WADENA, LLC
Active
Other names
Fair Oaks Lodge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC R. LUNDE (PRESIDENT)
(218) 631-1163
Entity
Organization
Contact information
Practice address
201 SHADY LANE DR, WADENA, MN 56482-3093
(218) 631-1391
Mailing address
201 SHADY LANE DR, WADENA, MN 56482-3093
(218) 631-1391
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
358367
MN
314000000X
Skilled Nursing Facility
Primary
357827
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
719475700
—
MN
01
—
9510SH
BCBS
—
Enumeration date
07/21/2005
Last updated
06/25/2013
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