NPIMap

Organization Active NPI

Pulaski Memorial Hospital

Doing business as Northern Lakes Nursing & Rehab Center

  • Skilled Nursing Facility
  • Angola, IN
National Provider Identifier
1306837869
Registry record updated Feb 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
050004261 Issued in IN
Legal business name
PULASKI MEMORIAL HOSPITAL
Doing business as
Northern Lakes Nursing & Rehab Center
Practice address
516 Williams St
Angola, IN 46703-1144
Phone
(260) 665-9467
Fax
(260) 624-2297
NPI assigned
Nov 3, 2005
Last updated
Feb 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2018

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

Authorized official

Name
Lisa Baker
Title
Corp Operations Manager
Phone
(812) 748-9155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 050004261 IN Primary

Addresses

Primary practice location

516 Williams St
Angola, IN 46703-1144

Mailing address

516 Williams St
Angola, IN 46703-1144
Phone (260) 665-9467

Other identifiers 1

IdentifierTypeStateIssuer
100275480MedicaidIN

Other names 1

  • Northern Lakes Nursing & Rehab Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151203001787 IN Part A Provider - Skilled Nursing Facility 3173515509 Practice locations: Angola, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306837869. Details of each certification follow.

Skilled nursing facility certification: CCN 155449

Legal name
PULASKI MEMORIAL HOSPITAL
Doing business as
NORTHERN LAKES NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jul 1, 1992
Last certification
Dec 10, 2024
Beds
99
Ownership / control type
Hospital District
Multi-facility organization
Pulaski Memorial Hospital
Organization structure
OtherNon-profit
Enrollment address
516 Williams St
Angola, IN 46703-1144
Nursing home name
NORTHERN LAKES NURSING AND REHABILITATION CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Northern Lakes Nursing and Rehabilitation CenterCCN 155449 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - Hospital district
Certified
Jul 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9982.5 residents per day on average
Penalties (3 years)
1Fines totaling $174,525

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0357528Northern Lakes Nursing & Rehab Center516 N Williams St, Angola, IN 46703Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Michael D Ramone DO43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Locations

516 Williams St
Angola, IN 46703
Phone (260) 665-9467

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gregg a Malott Individual Corporate DirectorDirector of Business Development Oct 1, 2015 100%
Operational/Managerial Control Oct 1, 2015
Pulaski Memorial Hospital Organization, Winamac, IN Operational/Managerial Control Oct 1, 2015 100%
Dee Anna Smallman Individual W-2 Managing EmployeeAdministrator Nov 20, 2000 100%
Donna Crover Individual W-2 Managing EmployeeDirector of Nursing May 27, 2005 100%
Angola Healthcare LLC Organization, Scottsburg, IN LLC Operational/Managerial Control Oct 1, 2015 100%

All facility ownership & control disclosures 27

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Envive of River CityEvansville, IN, CCN 155520 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2014
Jul 1, 2014
Majestic Care of West AllenFort Wayne, IN, CCN 155322 Skilled nursing facility Operational/Managerial Control (100%) Jun 1, 2015
Parkview HavenFrancesville, IN, CCN 155746 Skilled nursing facility Operational/Managerial Control (100%) Sep 1, 2015
Kingston Health Center of Fort WayneFort Wayne, IN, CCN 155479 Skilled nursing facility Operational/Managerial Control (100%) Dec 16, 2025
The Milton HomeSouth Bend, IN, CCN 155738 Skilled nursing facility Operational/Managerial Control (100%) Dec 1, 2016
Simmons Loving Care Health FacilityGary, IN, CCN 155845 Skilled nursing facility Operational/Managerial Control (100%) May 1, 2018
Maple Manor Christian HomeSellersburg, IN, CCN 155766 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2019
Saint AnthonyCrown Point, IN, CCN 155214 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020
Majestic Care of Jefferson PointeFort Wayne, IN, CCN 155446 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2020
Majestic Care of AvonAvon, IN, CCN 155338 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2020
Cardinal Care StrategiesMuncie, IN, CCN 155400 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 27, 2021
Majestic Care of CarmelCarmel, IN, CCN 155618 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Majestic Care of SouthportIndianapolis, IN, CCN 155247 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Poplar Care StrategiesLoogootee, IN, CCN 155374 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Sycamore Care StrategiesLoogootee, IN, CCN 155263 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Gentle Care StrategiesVincennes, IN, CCN 155519 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2022
Heritage CenterEvansville, IN, CCN 155104 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
Saint AnthonyWinamac, IN, CCN 155436 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2023
Hickory Creek at RochesterRochester, IN, CCN 155430 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2023
Briarcliff Health & Rehabilitation CenterSouth Bend, IN, CCN 155831 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 2024
South Shore Health & Rehabilitation CenterGary, IN, CCN 155530 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 2024
Asbury Towers Health Care CenterGreencastle, IN, CCN 155758 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2024
Jul 1, 2024
Pulaski Memorial HospitalWinamac, IN, CCN 158512 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 20, 2002
Mar 20, 2002
Pulaski Memorial Hospital Francesville Family MedicineFrancesville, IN, CCN 158528 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1989
Jan 1, 1989
Pulaski Memorial Hospital North Judson Family MedicineNorth Judson, IN, CCN 158527 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1989
Jan 1, 1989
Pulaski Memorial Hospital Knox Medical CenterKnox, IN, CCN 158554 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 1, 2019
Sep 1, 2019
Pulaski Memorial Hospital Culver Medical CenterCulver, IN, CCN 158581 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2024
Jan 1, 2024

Facilities with the same owner 27

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 27

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519603200000",
    "number": "1306837869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 WILLIAMS ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467031144",
            "telephone_number": "260-665-9467",
            "fax_number": "260-624-2297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 WILLIAMS ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467031144",
            "telephone_number": "260-665-9467",
            "fax_number": "260-624-2297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2018-02-26",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CORP OPERATIONS MANAGER",
        "authorized_official_telephone_number": "812-748-9155"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "050004261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100275480",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Lakes Nursing & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Lakes Nursing & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Angola, IN

Sources for this page

Verify at the official NPI Registry.