Lake Region Lutheran Home, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LAKE REGION LUTHERAN HOME, INC.

Doing business as

Eventide Lake Country Manor Basic Care

Practice address

1332 10TH St NE
Devils Lake, ND 58301-2329

Phone

(701) 662-1880

Fax

(701) 662-1084

NPI assigned

Jun 11, 2019

Last updated

Jun 11, 2019By 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

Jon Riewer

Title

President & Ceo

Phone

(218) 291-2201

Specialties & licenses 1

Addresses

Other names 1

• Eventide Lake Country Manor Basic Care Doing business as

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

CLIA laboratory certificates

Tax ID family

Eventide Lake Country Manor Basic Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lake Region Lutheran Home, Inc.

  dba Heartland Care Center

  • Nursing Facility/Intermediate Care Facility
  • Devils Lake, ND
  • NPI 1689667834
  NPD tax ID

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1619536976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 MAIN AVE STE 201",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602871",
            "telephone_number": "218-291-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1332 10TH ST NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012329",
            "telephone_number": "701-662-1880",
            "fax_number": "701-662-1084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGION LUTHERAN HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "RIEWER",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "218-291-2201"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eventide Lake Country Manor Basic Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lake Region District Health Unit
• Lake Region Family Planning Program
• Lake Region Human Service Center
• Lake Region Law Enforcement Center
• Lake Region Lutheran Home, Inc. (Eventide Devils Lake Care Center)
• Lake Region Lutheran Home, Inc. (Heartland Care Center)
• Lake Region Special Education
• Lake to Prairie Investments LLC (All of Us In Recovery)
• Tania Lakoduk
• Lori Ellen Landsem

• Assisted Living Facility in Devils Lake, ND
• Providers in Devils Lake, ND by specialty
• Assisted Living Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.