Provider Demographics
NPI:1134788896
Name:4 LAKES HEALTH SERVICES, INC
Entity type:Organization
Organization Name:4 LAKES HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERENST
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-297-7644
Mailing Address - Street 1:1730 28 3/4 AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-9329
Mailing Address - Country:US
Mailing Address - Phone:715-296-7644
Mailing Address - Fax:
Practice Address - Street 1:437 S YELLOWSTONE DR STE 210
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1061
Practice Address - Country:US
Practice Address - Phone:608-315-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care