Manor of Lake City, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

130137 Issued in IA

Legal business name

MANOR OF LAKE CITY, INC

Doing business as

Shady Oaks

Practice address

1409 W Main St
Lake City, IA 51449-1578

Phone

(712) 464-3106

Fax

(712) 464-8042

NPI assigned

Aug 29, 2006

Organization subpart

No

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

Authorized official

Name

Jack Dean Vetter

Title

President

Phone

(402) 895-3932

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shady Oaks Doing business as

Locations

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962510859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491578",
            "telephone_number": "712-464-3106",
            "fax_number": "712-464-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491578",
            "telephone_number": "712-464-3106",
            "fax_number": "712-464-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR OF LAKE CITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VETTER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-895-3932"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "130137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807644",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shady Oaks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Beth Lapham, LISW
• Kaylynn Marie Larson, RN, BSN
• Luke A Larson
• James Edward Lewis, CRNA
• Larry D Lieb, CRNA ARNP
• Jane Moeller
• Lesa Renee Nobiling
• North Central Iowa Mental Health Center Inc (UnityPoint Health-Berryhill Center)
• North Central Iowa Mental Health Center, Inc (Berryhill Center for Mental Health)
• Northland Hearing Centers, Inc (Hearing Services of Iowa at Center for Health Services)

• Skilled Nursing Facility in Lake City, IA
• Providers in Lake City, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.