Provider Demographics
NPI:1043205917
Name:LSS HOME HEALTH AND HOSPICE, LLC
Entity Type:Organization
Organization Name:LSS HOME HEALTH AND HOSPICE, LLC
Other - Org Name:LEGACY HOME HEALTH AND HOSPICE SERVICES OF WADENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-631-1391
Mailing Address - Street 1:201 SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-3093
Mailing Address - Country:US
Mailing Address - Phone:218-632-1335
Mailing Address - Fax:218-632-1336
Practice Address - Street 1:201 SHADY LANE DR
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-3093
Practice Address - Country:US
Practice Address - Phone:218-632-1335
Practice Address - Fax:218-632-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN357793251E00000X
MN357794251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN291990700Medicaid
MN247238Medicare Oscar/Certification
MN241553Medicare Oscar/Certification