NPIMap

Organization Active NPI

Sky Lakes Medical Center Inc

  • Home Health Agency
  • Klamath Falls, OR
National Provider Identifier
1568417103
Registry record updated Oct 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
13 140724 Issued in OR
Legal business name
SKY LAKES MEDICAL CENTER INC
Practice address
2421 Washburn Way Ste F
Klamath Falls, OR 97603-4531
Phone
(541) 274-6293
Fax
(541) 274-6294
NPI assigned
May 23, 2006
Last updated
Oct 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2026

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

Authorized official

Name
Lisa Drewslucero
Title
Director of Home Health
Phone
(541) 891-1843

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 13 140724 OR Primary

Addresses

Primary practice location

2421 Washburn Way Ste F
Klamath Falls, OR 97603-4531

Mailing address

2421 Washburn Way Ste F
Klamath Falls, OR 97603-4531
Phone (541) 274-6293

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050708000458 OR Part A Provider - Home Health Agency 1052204096 Practice locations: Klamath Falls, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568417103. Details of each certification follow.

Home health agency certification: CCN 387075

Legal name
SKY LAKES MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 9, 1984
Last certification
Oct 11, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 1987 in OR
Enrollment address
2421 Washburn Way
Ste F
Klamath Falls, OR 97603-4531

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Sky Lakes Home HealthCCN 387075 · All quality measures
Overall star rating
2 of 5
Ownership
Non-Profit
Certified
Mar 9, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy

National Provider Directory

National Provider Directory

Locations

2421 Washburn Way
Klamath Falls, OR 97603
Phone (541) 883-6289

2605 Crosby Ave
Klamath Falls, OR 97603
Phone (541) 274-2895

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Douglas McInnis Individual Corporate DirectorBoard Member Jan 1, 2012
Andrew M Molatore Individual Corporate DirectorPatient Financial Services Oct 1, 2007
W-2 Managing EmployeePatient Financial Services Oct 1, 2007
Lisa Carol Drews-Lucero Individual W-2 Managing EmployeeDirector Feb 5, 2022 50%
Kermit Houser Individual Corporate DirectorBoard Member Jan 1, 2012
Dwight W Smith Individual Corporate DirectorBoard Member Oct 1, 2014
Richard Rico Individual Corporate OfficerVP / Cfo Jan 30, 2009
W-2 Managing EmployeeVP / Cfo Jan 30, 2009
Operational/Managerial ControlVP / Cfo Jan 30, 2009
Clark Pederson Individual Corporate DirectorBoard Member Jan 1, 2012
Holly L Montjoy Individual Corporate DirectorBoard Member Oct 1, 2016
Wendy a Warren Individual Corporate DirectorBoard Member Jan 1, 2012
Annette Cole Individual Corporate Officer Feb 1, 2009
W-2 Managing Employee Feb 1, 2009
Roderick C Wendt Individual Corporate DirectorBoard Member Jan 1, 2012
John Bell Individual Corporate DirectorBoard Member Jan 1, 2012
Paul Stewart Individual Corporate OfficerPresident / Ceo Oct 12, 1956
W-2 Managing EmployeePresident / Ceo Oct 12, 1956
Operational/Managerial ControlPresident / Ceo Oct 12, 1956
OtherBoard Member Oct 12, 1956

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793145600000",
    "number": "1568417103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 WASHBURN WAY STE F",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976034531",
            "telephone_number": "541-274-6293",
            "fax_number": "541-274-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 WASHBURN WAY STE F",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976034531",
            "telephone_number": "541-274-6293",
            "fax_number": "541-274-6294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKY LAKES MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2026-10-28",
        "certification_date": "2026-10-28",
        "status": "A",
        "authorized_official_last_name": "DREWSLUCERO",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "DIRECTOR OF HOME HEALTH",
        "authorized_official_telephone_number": "541-891-1843"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OR",
            "license": "13 140724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.