Organization
LAKESHORE INN NURSING HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. R. P. MADEL III (ADMINISTRATOR)
(507) 835-2800
Entity
Organization
Contact information
Practice address
108 8TH ST NW, WASECA, MN 56093-1912
(507) 835-2800
(507) 833-1391
Mailing address
108 8TH ST NW, WASECA, MN 56093-1912
(507) 835-2800
(507) 833-1391
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
9058850
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
593043000
—
MN
01
—
7100427
MEDICA
MN
01
—
8656LA
BCBS OF MN
MN
01
—
NH0444
UCARE/SCHA
MN
Enumeration date
06/13/2005
Last updated
02/23/2017
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