NPIMap

Organization Active NPI

Lake City Medical Investors, LLC

  • Skilled Nursing Facility
  • Coeur D Alene, ID
National Provider Identifier
1366495277
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
65 Issued in ID
Legal business name
LAKE CITY MEDICAL INVESTORS, LLC
Practice address
500 W Aqua Ave
Coeur D Alene, ID 83815-7764
Phone
(208) 762-1122
Fax
(208) 762-9191
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Authorized official

Name
Cindy S. Cross
Title
Assistant Secretary
Phone
(423) 473-5867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 65 ID Primary

Addresses

Primary practice location

500 W Aqua Ave
Coeur D Alene, ID 83815-7764

Mailing address

3001 Keith St NW
Cleveland, TN 37312-3713
Phone (423) 473-5751

Other identifiers 1

IdentifierTypeStateIssuer
0021309MedicaidID

Other names 1

  • Life Care Center of Coeur D'Alene Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040707001036 ID Part A Provider - Skilled Nursing Facility 0547247520 Practice locations: Coeur D Alene, ID

Skilled nursing facility certification: CCN 135122

Legal name
LAKE CITY MEDICAL INVESTORS LLC
Doing business as
LIFE CARE CENTER OF COEUR D' ALENE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 27, 1996
Last certification
Oct 5, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Life Care Centers of America
Organization structure
LLCProprietary
Enrollment address
500 W Aqua Ave
Coeur D Alene, ID 83815-7764
Nursing home name
LIFE CARE CENTER OF COEUR D'ALENE
Affiliated entity
LIFE CARE CENTERS OF AMERICA

Care Compare: Nursing home

Medicare Care Compare
Listed as
Life Care Center of Coeur d'AleneCCN 135122
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 27, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12082.4 residents per day on average
Chain
Life Care Centers of America194 facilities in the chain
Penalties (3 years)
1Fines totaling $39,520

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

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
Forrest L Preston Individual 5% Or Greater Direct Ownership InterestMember Jul 14, 1994 99%
Joan E Thurmond Individual Corporate OfficerAsst Secretary of Corp. MGR. Sep 21, 2000
Cindy S Cross Individual Corporate OfficerVP of Corporate Manager Jul 14, 1994
Life Care Centers of America, Inc. Organization, Cleveland, TN Corporation, Management services company, For-profit Operational/Managerial Control Jun 12, 1995 100%
Jodi Johnson Individual W-2 Managing EmployeeAdministrator Jan 3, 2022

Owners & managing parties with NPI records 25

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 25

Facilities with the same owner 193

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

View all 193

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783641600000",
    "number": "1366495277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373123713",
            "telephone_number": "423-473-5751",
            "fax_number": "423-339-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W AQUA AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838157764",
            "telephone_number": "208-762-1122",
            "fax_number": "208-762-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY MEDICAL INVESTORS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A",
        "authorized_official_last_name": "CROSS",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "423-473-5867"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "65",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0021309",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "284 Merchant St",
            "city": "Ste Genevieve",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636701610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Life Care Center of Coeur D'Alene",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.