Provider Demographics
NPI:1265468177
Name:LAKES AREA MEDICAL
Entity Type:Organization
Organization Name:LAKES AREA MEDICAL
Other - Org Name:SABINE NECHES HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-735-6100
Mailing Address - Street 1:150 LA MESA
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-3020
Mailing Address - Country:US
Mailing Address - Phone:409-735-6100
Mailing Address - Fax:409-735-3783
Practice Address - Street 1:150 LA MESA
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-3020
Practice Address - Country:US
Practice Address - Phone:409-735-6100
Practice Address - Fax:409-735-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457824Medicare ID - Type Unspecified