Provider Demographics
NPI:1093719973
Name:LAKEWOOD QUARTERS ASSISTED 8585 TENANT, LLC
Entity Type:Organization
Organization Name:LAKEWOOD QUARTERS ASSISTED 8585 TENANT, LLC
Other - Org Name:LAKEWOOD QUARTERS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-390-4363
Mailing Address - Street 1:8585 SUMMA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-0608
Mailing Address - Country:US
Mailing Address - Phone:225-767-7877
Mailing Address - Fax:
Practice Address - Street 1:8585 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-0608
Practice Address - Country:US
Practice Address - Phone:225-767-7612
Practice Address - Fax:225-767-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5943310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility