LSS of Wadena, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

357827 Issued in MN

Legal business name

LSS OF WADENA, LLC

Doing business as

Fair Oaks Lodge

Practice address

201 Shady Lane Dr
Wadena, MN 56482-3093

Phone

(218) 631-1391

NPI assigned

Jul 21, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Eric R. Lunde

Title

President

Phone

(218) 631-1163

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Fair Oaks Lodge Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Astera Health

  dba Astera Health Wadena Clinic

  • Rural Health Clinic/Center
  • Wadena, MN
  • NPI 1134305162

  Member Of

  NPD member
• Legacy Senior Services

  dba Frazee Care Center

  • Skilled Nursing Facility
  • Frazee, MN
  • NPI 1255510889

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1043210925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SHADY LANE DR",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564823093",
            "telephone_number": "218-631-1391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SHADY LANE DR",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564823093",
            "telephone_number": "218-631-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LSS OF WADENA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "LUNDE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-631-1163",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "358367",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "357827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "719475700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9510SH",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fair Oaks Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Lindblom, DO
• Megan Elizabeth Lindblom, PHARMD
• Macayla Rose Lindenfelser, NP-C
• Rose Ann Lorentz, A-G NP
• LSS Home Health and Hospice, LLC (Legacy Home Health and Hospice Services of Wadena)
• Zachary Lundgren, OD
• Elizabeth Marie Marshall, OD
• Brooke Martinez, M.S. LMFT
• James H Matthiae, DDS
• Tori Corrine Ione McDougald

• Skilled Nursing Facility in Wadena, MN
• Providers in Wadena, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.