SHADY OAKS
NPI 1962510859
Skilled Nursing Facility in Lake City, IA

Active since August 29, 2006CLIA 16D0385662 · Waiver
1409 W MAIN ST, LAKE CITY, IA 51449(712) 464-3106(712) 464-8042 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Shady Oaks NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY OAKS (NPI 1962510859) is a healthcare organization registered as a skilled nursing facility in Lake City, Iowa and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Jack Dean Vetter, President, as its authorized official.

NPPES Registry Identity

NPI1962510859
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameMANOR OF LAKE CITY, INC
Location Address1409 W MAIN STLake City, IA 51449-1578
Mailing Address1409 W Main StLake City, IA 51449-1578 · (712) 464-3106 · Fax (712) 464-8042
Fax(712) 464-8042
Organization SubpartNo
Authorized OfficialJack Dean VetterPresident · (402) 895-3932
Enumeration DateAugust 29, 2006
Last NPPES UpdateAugust 22, 2020
NPI 1962510859 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in IA · 130137
Definition

(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

1409 W MAIN ST, Lake City, IA 51449

Other Names 1

Doing Business AsShady Oaks

Other Identifiers 1

Medicaid807644IA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 16D0385662

Accura Healthcare Of Lake City LLC · Lake City, IA
Active · expires Aug 31, 2026
CLIA Number16D0385662
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorMichelle Ferguson
Laboratory Phone(712) 464-3106
Laboratory LocationAccura Healthcare Of Lake City LLC1409 West Main Street, Lake City, IA 51449
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
1409 W MAIN ST
LAKE CITY, IA 51449
Occupational Therapist
1409 W MAIN ST
LAKE CITY, IA 51449
Skilled Nursing Facility
1409 W MAIN ST
LAKE CITY, IA 51449

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Manor Of Lake City, Inc's NPI number?

The NPI number for Manor Of Lake City, Inc is 1962510859. It was assigned to this organization in the NPPES registry on August 29, 2006. The provider is doing business as Shady Oaks.

Where is Manor Of Lake City, Inc located?

Manor Of Lake City, Inc is located at 1409 W Main St, Lake City, IA 51449. The listed phone number is (712) 464-3106.

What is Manor Of Lake City, Inc's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Manor Of Lake City, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 16D0385662) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Manor Of Lake City, Inc was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.