Lake Island Healthcare, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LAKE ISLAND HEALTHCARE, INC.

Practice address

2050 S Main St
Delta, CO 81416-2407

Phone

(970) 874-9773

NPI assigned

Jul 31, 2019

Organization subpart

No

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

Authorized official

Name

Soon Burnam

Title

Treasurer

Phone

(949) 540-1249

Specialties & licenses 1

Addresses

Other names 1

• Willow Tree Care Center Doing business as

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1902450604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S MAIN ST",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814162407",
            "telephone_number": "970-874-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 S MAIN ST",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814162407",
            "telephone_number": "970-874-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ISLAND HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Tree Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Tree Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John P Knutson, MD
• Sara W Knutson, MD
• Maxim A Kondratenko, DDS
• Elizabeth Kotwasinski, MSW
• Kyle Nickel MD, PC
• Joshua Lake
• Kenneth B Lake, CRNA
• Gregory Lee Lane, D.C.
• Robert L Lang, MA
• Ryan Latter

• Skilled Nursing Facility in Delta, CO
• Providers in Delta, CO by specialty
• Skilled Nursing Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.