Basic Information
| Provider Information | |||||||||
| NPI: | 1780718916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKEPOINT AUGUSTA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | D/B/A LAKEPOINT NURSING CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 LAKEPOINT DRIVE | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167762194 | ||||||||
| FaxNumber: | 3167769370 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 LAKEPOINT DR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670102423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167762194 | ||||||||
| FaxNumber: | 3167769370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | LAVALLEE | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3167756333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 100108500B | 05 | KS | MEDICAID |