Provider Demographics
NPI:1275536609
Name:LAKEPOINT WICHITA, LLC
Entity Type:Organization
Organization Name:LAKEPOINT WICHITA, LLC
Other - Org Name:LAKEPOINT RETIREMENT & REHAB CENTER OF WICHITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAVALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-260-9494
Mailing Address - Street 1:1315 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1382
Mailing Address - Country:US
Mailing Address - Phone:316-943-1294
Mailing Address - Fax:316-943-8190
Practice Address - Street 1:1315 N WEST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1382
Practice Address - Country:US
Practice Address - Phone:316-943-1294
Practice Address - Fax:316-943-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087049251E00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100429630AMedicaid
KS100455930AMedicaid
KS175466Medicare Oscar/Certification