Provider Demographics
NPI:1033440458
Name:LAKE VIEW TERRACE MEMORY CARE
Entity Type:Organization
Organization Name:LAKE VIEW TERRACE MEMORY CARE
Other - Org Name:LHC PARTNERS LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-855-8099
Mailing Address - Street 1:320 LAKE HAVASU AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-4701
Mailing Address - Country:US
Mailing Address - Phone:928-855-8099
Mailing Address - Fax:928-855-6666
Practice Address - Street 1:320 LAKE HAVASU AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-4701
Practice Address - Country:US
Practice Address - Phone:928-855-8099
Practice Address - Fax:928-855-6666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LHC PARTNERS, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)