Provider Demographics
NPI:1366612251
Name:LAKES COMMUNITIES INC
Entity type:Organization
Organization Name:LAKES COMMUNITIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-662-6646
Mailing Address - Street 1:403 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56150-9573
Mailing Address - Country:US
Mailing Address - Phone:507-662-6646
Mailing Address - Fax:507-662-5531
Practice Address - Street 1:403 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:LAKEFIELD
Practice Address - State:MN
Practice Address - Zip Code:56150-9573
Practice Address - Country:US
Practice Address - Phone:507-662-6646
Practice Address - Fax:507-662-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335723314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN075487000Medicaid
245572Medicare Oscar/Certification