VSL Lake City LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

130137 Issued in IA

Legal business name

VSL LAKE CITY LLC

Doing business as

Shady Oaks

Practice address

1409 W Main St
Lake City, IA 51449-1578

Phone

(712) 464-3106

Fax

(712) 464-8042

NPI assigned

Jun 15, 2017

Organization subpart

No

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

Authorized official

Name

Jack D Vetter

Title

Ceo

Phone

(402) 895-3932

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shady Oaks Doing business as

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497484800000",
    "number": "1174053771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20220 HARNEY ST",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680222063",
            "telephone_number": "402-885-6120",
            "fax_number": "402-895-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491578",
            "telephone_number": "712-464-3106",
            "fax_number": "712-464-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VSL LAKE CITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2017-06-15",
        "status": "A",
        "authorized_official_last_name": "VETTER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-895-3932"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "130137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY LICENSE",
            "identifier": "130137",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shady Oaks",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shady Oaks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stewart Memorial Community Hospital
• Gina Stork, LMHC
• Maurine Thieszen, R.D.
• David Joseph Verbik, DDS PHD
• Margaret Mary Vitiritto Khan, DO
• Cassandra M Wetter, R.D.
• Woodlawn Pharmacy

• Skilled Nursing Facility in Lake City, IA
• Providers in Lake City, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2017; 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.