- Enrollment id
- O20021010000039
- Enrollment state
- SD
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1356342851
- Multiple npi flag
- N
- Ccn
- 435097
- Associate id
- 5294642872
- Organization name
- LAKE ANDES HEALTH CARE CENTER, INC.
- Doing business as name
- LAKE ANDES SENIOR LIVING
- Incorporation date
- 1997-06-17
- Incorporation state
- MN
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- LAKE ANDES SENIOR LIVING
- Affiliation entity name
- ACCURA HEALTHCARE
- Affiliation entity id
- 8
- Address line 1
- 740 E LAKE ST
- City
- LAKE ANDES
- State
- SD
- Zip code
- 573562001