Provider Demographics
NPI:1073957908
Name:LAKEWOOD VILLA OPERATIONS, LLC
Entity Type:Organization
Organization Name:LAKEWOOD VILLA OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF A/R-COLORADO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-876-9252
Mailing Address - Street 1:26522 LA ALAMEDA STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8302
Mailing Address - Country:US
Mailing Address - Phone:949-449-2500
Mailing Address - Fax:
Practice Address - Street 1:1625 SIMMS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2611
Practice Address - Country:US
Practice Address - Phone:303-238-8161
Practice Address - Fax:303-238-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X, 385H00000X
COTBD314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74559834Medicaid