Lakeside Healthcare LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

40127 Issued in SD

Legal business name

LAKESIDE HEALTHCARE LLC

Practice address

1010 W 5TH St
Redfield, SD 57469-2026

Phone

(605) 472-2191

Fax

(605) 472-2194

NPI assigned

Aug 19, 2010

Last updated

Aug 19, 2010By 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

Rosanne A Lemmer

Title

Administrator

Phone

(605) 472-2191

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Kayla Marie Jessen, OWNER

  • Assisted Living Facility
  • Redfield, SD
  • NPI 1922986447
  NPD (past)

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

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282176000000",
    "number": "1780990457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 W 5TH ST",
            "city": "REDFIELD",
            "state": "SD",
            "postal_code": "574692026",
            "telephone_number": "605-472-2191",
            "fax_number": "605-472-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W 5TH ST",
            "city": "REDFIELD",
            "state": "SD",
            "postal_code": "574692026",
            "telephone_number": "605-472-2191",
            "fax_number": "605-472-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-19",
        "last_updated": "2010-08-19",
        "status": "A",
        "authorized_official_last_name": "LEMMER",
        "authorized_official_first_name": "ROSANNE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-472-2191"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "SD",
            "license": "40127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9571840",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne Jockheck, LPC
• Sandra Jungwirth, PT,DPT
• Tonja Jean Jungwirth, M.S., LPC-MH
• Jade Koch, DDS
• Lakeside Assisted Living, LLC
• Marisa Sue Lakner, PT
• Donna May Luckhurst, MA, PT
• Cari L. Mack, R,PH.
• Haley Nicole Mason, CNP
• Shelby Mehlberg

• Exclusive Provider Organization in Redfield, SD
• Providers in Redfield, SD by specialty
• Exclusive Provider Organization in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2010; 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.