Provider Demographics
NPI:1083816797
Name:LAKEWOOD CARE CENTER
Entity Type:Organization
Organization Name:LAKEWOOD CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-483-7000
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0177
Mailing Address - Country:US
Mailing Address - Phone:704-483-7000
Mailing Address - Fax:704-483-3953
Practice Address - Street 1:7981 OPTIMIST CLUB ROAD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-0177
Practice Address - Country:US
Practice Address - Phone:704-483-7000
Practice Address - Fax:704-483-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL055003310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801322Medicaid