Provider Demographics
NPI:1164431003
Name:SUMMIT VIEW OF LAKE CITY, LLC
Entity Type:Organization
Organization Name:SUMMIT VIEW OF LAKE CITY, LLC
Other - Org Name:LAKE CITY HEALTH CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, MBA
Authorized Official - Phone:865-675-6444
Mailing Address - Street 1:204 INDUSTRIAL PARK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37769-2301
Mailing Address - Country:US
Mailing Address - Phone:865-426-2147
Mailing Address - Fax:865-426-7144
Practice Address - Street 1:204 INDUSTRIAL PARK LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:TN
Practice Address - Zip Code:37769-2301
Practice Address - Country:US
Practice Address - Phone:865-426-2147
Practice Address - Fax:865-426-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445259Medicaid
TN114355OtherBC/BS
TN7440360Medicaid
TN445259Medicare Oscar/Certification