Provider Demographics
NPI:1013910439
Name:LAKELAND HOSPICE, INC.
Entity Type:Organization
Organization Name:LAKELAND HOSPICE, INC.
Other - Org Name:LAKELAND HOSPICE AND HOME CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-998-1400
Mailing Address - Street 1:1505 PEBBLE LAKE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-3858
Mailing Address - Country:US
Mailing Address - Phone:218-998-1400
Mailing Address - Fax:218-998-1420
Practice Address - Street 1:1505 PEBBLE LAKE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-3858
Practice Address - Country:US
Practice Address - Phone:218-998-1400
Practice Address - Fax:218-998-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333772251E00000X
MN333817251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6J75LAOtherHOME CARE BCBS
MN50-25406OtherHOSPICE MEDICA
MN737565400Medicaid
MN59-00133OtherHOME CARE MEDICA
MN777223800Medicaid
MN2Z97LAOtherHOSPICE BCBS
MN6J75LAOtherHOME CARE BCBS
MN59-00133OtherHOME CARE MEDICA