Provider Demographics
NPI:1184246639
Name:LCS SANTA ROSA LLC
Entity type:Organization
Organization Name:LCS SANTA ROSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-875-4500
Mailing Address - Street 1:400 LOCUST ST STE 820
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2334
Mailing Address - Country:US
Mailing Address - Phone:515-875-4500
Mailing Address - Fax:844-319-0816
Practice Address - Street 1:300 FOUNTAINGROVE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-5720
Practice Address - Country:US
Practice Address - Phone:707-566-8600
Practice Address - Fax:844-319-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility