Basic Information
| Provider Information | |||||||||
| NPI: | 1730651001 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKEVIEW NURSING & REHAB LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | BELLA VISTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727158462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797156759 | ||||||||
| FaxNumber: | 4797156922 | ||||||||
| Practice Location | |||||||||
| Address1: | 607 WOODLAND ST | ||||||||
| Address2: | |||||||||
| City: | EUFAULA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744323611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186892508 | ||||||||
| FaxNumber: | 4052525632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2018 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | BRADFORD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4798992010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.