Provider Demographics
NPI:1558071910
Name:LAKE VALLEY HOSPICE LLC
Entity Type:Organization
Organization Name:LAKE VALLEY HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-668-2204
Mailing Address - Street 1:4517 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4073
Mailing Address - Country:US
Mailing Address - Phone:632-200-4677
Mailing Address - Fax:763-243-8110
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3980
Practice Address - Country:US
Practice Address - Phone:623-236-0724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based