| Organization Name: | LAKE REGION HOME MEDICAL, LLC |
| NPI Number: | 1063834778 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM FENSKE (CFO) |
| Mailing Address: | 1432 W Lincoln Ave Fergus Falls |
| State: | MN US |
| Postal Code: | 565371032 |
| Phone Number: | 3202631349 |
| Fax Number: | |
| NPI Enumeration Date: | 01/15/2014 |
| NPI Last Update Date: | 03/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |