LAKESHORE ASSISTED LIVING LLC
NPI 1033856166
Assisted Living Facility in Waseca, MN

Active since May 19, 2022CLIA 24D2265749 · Waiver
105 8TH ST NW, WASECA, MN 56093(507) 625-8741 Get Directions Write a Review

NPPES record last updated: September 13, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 13, 2022, May 19, 2022 (2 updates tracked since 2022).

  • Organization
  • Assisted Living Facility
  • CLIA Number: 24D2265749
  • CLIA Cert. Type: Assisted Living Facility
  • CLIA Exp. Date: 08-01-2026

About LAKESHORE ASSISTED LIVING LLC

This page provides the complete NPI Profile along with additional information for Lakeshore Assisted Living Llc, a provider established in Waseca, Minnesota operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1033856166 assigned on May 2022. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The authorized official of this NPI record is Ian Rekant (Vp Of Rcm)

NPI
1033856166 Verify this NPI
Provider Name
LAKESHORE ASSISTED LIVING LLC
Entity Type
Organization
Location Address
105 8TH ST NW WASECA, MN 56093
Location Phone
(507) 625-8741
Mailing Address
638 SOUTHBEND AVE MANKATO, MN 56001
Mailing Phone
(507) 625-8741
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
05-19-2022
Last Update Date
09-13-2022
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
Taxonomy Description
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

IAN REKANT

Authorized Official Title
VP OF RCM
Authorized Official Phone
(507) 203-1031

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
24D2265749
Facility Type
Assisted Living Facility
Certificate Effective Date
August 02, 2024
Certificate Expiration Date
August 01, 2026
Laboratory Director
MARLENE ROBRAN
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Lakeshore Assisted Living Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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Other Providers at the Same Location


The following 1 provider is registered at the same or a nearby location.

Assisted Living Facility
105 8TH ST NW
WASECA, MN 56093

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1033856166, enumerated as an "organization" on May 19, 2022.

The provider is located at 105 8TH ST NW WASECA, MN 56093 and the phone number is (507) 625-8741.

Assisted Living Facility with taxonomy code 310400000X.