Provider Demographics
NPI:1801016027
Name:LAKES HOSPICE LLC
Entity type:Organization
Organization Name:LAKES HOSPICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-634-4900
Mailing Address - Street 1:1703 W 5TH ST STE 800
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4893
Mailing Address - Country:US
Mailing Address - Phone:512-634-4900
Mailing Address - Fax:512-634-4966
Practice Address - Street 1:1370 LAKE ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1100
Practice Address - Country:US
Practice Address - Phone:712-336-2941
Practice Address - Fax:712-336-2591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOYAGER HOSPICECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0000006Medicaid
IA161586Medicare Oscar/Certification