Provider Demographics
NPI:1073636296
Name:LAKES COMMUNITIES, INC.
Entity Type:Organization
Organization Name:LAKES COMMUNITIES, INC.
Other - Org Name:LAKEVIEW HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ROCHELEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-631-0714
Mailing Address - Street 1:211 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3064
Mailing Address - Country:US
Mailing Address - Phone:320-631-0714
Mailing Address - Fax:320-631-0009
Practice Address - Street 1:941 COUNTY ROAD 9
Practice Address - Street 2:
Practice Address - City:HERON LAKE
Practice Address - State:MN
Practice Address - Zip Code:56137-1408
Practice Address - Country:US
Practice Address - Phone:507-793-2349
Practice Address - Fax:507-793-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331784314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245582Medicare Oscar/Certification