Lakeside Nursing Home, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5401307N Issued in NY

Legal business name

LAKESIDE NURSING HOME, INC

Practice address

1229 Trumansburg Road
Ithaca, NY 14850-1313

Phone

(607) 273-8072

Fax

(607) 273-0373

NPI assigned

Apr 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Patrick M Deptula

Title

Administrator

Phone

(607) 273-8072

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053535617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 TRUMANSBURG RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501313",
            "telephone_number": "607-273-8072",
            "fax_number": "607-273-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 TRUMANSBURG ROAD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501313",
            "telephone_number": "607-273-8072",
            "fax_number": "607-273-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE NURSING HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEPTULA",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "607-273-8072",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5401307N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NOW",
            "identifier": "000900083000",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00308181",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shirley Anne Ladd, NP, LCSW
• Trisha A Ladley, LCSW
• Karen M Laface, MD
• Rosanne Oddi Lahr, RN BSN
• Andrea Marie Lajoie, MSW, LCSW-R
• Michael Jon Lakin, PHD
• Kira Lallas, LCSW
• Cynthia Ann Lalonde, RN
• Gabriella Lam
• Catherine Schano Lama, RN

• Skilled Nursing Facility in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.