Provider Demographics
NPI:1114950524
Name:LSI SERVICES, LLC
Entity Type:Organization
Organization Name:LSI SERVICES, LLC
Other - Org Name:COLONIAL MANOR OF BALATON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MADEL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:507-734-3511
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:551 US HWY 14
Mailing Address - City:BALATON
Mailing Address - State:MN
Mailing Address - Zip Code:56115
Mailing Address - Country:US
Mailing Address - Phone:507-734-3511
Mailing Address - Fax:507-734-2337
Practice Address - Street 1:551 US HWY 14
Practice Address - Street 2:
Practice Address - City:BALATON
Practice Address - State:MN
Practice Address - Zip Code:56115
Practice Address - Country:US
Practice Address - Phone:507-734-3511
Practice Address - Fax:507-734-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331952314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH0252OtherUCARE
MN570014400Medicaid
MN4743COOtherBC
MN4743COOtherBC