Provider Demographics
NPI:1134514961
Name:LAKEWOOD HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:LAKEWOOD HEALTH CARE CENTER, INC.
Other - Org Name:ENNISCOURT ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:216-226-3858
Mailing Address - Street 1:13323 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2849
Mailing Address - Country:US
Mailing Address - Phone:216-226-3858
Mailing Address - Fax:216-226-8344
Practice Address - Street 1:13323 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2849
Practice Address - Country:US
Practice Address - Phone:216-226-3858
Practice Address - Fax:216-226-8344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEWOOD HEALTH CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-30
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0506R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility