Provider Demographics
NPI:1033460936
Name:LAKEVIEW NEUROREHAB CENTER MIDWEST, INC.
Entity Type:Organization
Organization Name:LAKEVIEW NEUROREHAB CENTER MIDWEST, INC.
Other - Org Name:LAKEVIEW SPECIALTY HOSPITAL & REAHB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO & ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-534-7297
Mailing Address - Street 1:1701 SHARP RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-5214
Mailing Address - Country:US
Mailing Address - Phone:262-534-7297
Mailing Address - Fax:262-534-7257
Practice Address - Street 1:1701 SHARP RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-5214
Practice Address - Country:US
Practice Address - Phone:262-534-7297
Practice Address - Fax:262-534-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66049293416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport