Organization
LAKESIDE LUTHERAN HOME
Active
Other names
Lakeside Lutheran Home
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY E PORATH (PRESIDENT)
(712) 852-4060
Entity
Organization
Contact information
Practice address
301 N LAWLER ST, EMMETSBURG, IA 50536-1073
(712) 852-4060
(712) 852-9914
Mailing address
301 N LAWLER ST, EMMETSBURG, IA 50536-1073
(712) 852-4060
(712) 852-9914
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
740436
IA
314000000X
Skilled Nursing Facility
Primary
740436
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0802181
—
IA
Enumeration date
10/26/2006
Last updated
12/21/2011
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