- Enrollment id
- O20040402001262
- Enrollment state
- IA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1972566875
- Multiple npi flag
- N
- Ccn
- 161562
- Associate id
- 0941118442
- Organization name
- LAKES REGIONAL HEALTHCARE
- Doing business as name
- LAKES REGIONAL HEALTHCARE HOSPICE
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Address line 1
- 2301 HIGHWAY 71
- City
- SPIRIT LAKE
- State
- IA
- Zip code
- 513601253