Organization
VSL LAKE CITY LLC
Active
Other names
Shady Oaks
Organization subpart
No
Provider details
NPI number
Authorized official
JACK D VETTER (CEO)
(402) 895-3932
Entity
Organization
Contact information
Practice address
1409 W MAIN ST, LAKE CITY, IA 51449-1578
(712) 464-3106
(712) 464-8042
Mailing address
20220 HARNEY ST, ELKHORN, NE 68022-2063
(402) 885-6120
(402) 895-8165
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
130137
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130137
FACILITY LICENSE
IA
Enumeration date
06/15/2017
Last updated
06/15/2017
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