Basic Information
| Provider Information | |||||||||
| NPI: | 1760013809 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST WHARTON COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAKEVIEW REHABILITATION AND HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6937 WARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | SYKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217847454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105524800 | ||||||||
| FaxNumber: | 4105524837 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 E COKE RD | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754943416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033426951 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2020 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | MAK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7135697370 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001031806 | 05 | TX | MEDICAID |