Provider Demographics
NPI:1275814261
Name:LAKEVIEW HOME CARE PHASE II, LLC
Entity Type:Organization
Organization Name:LAKEVIEW HOME CARE PHASE II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-222-9811
Mailing Address - Street 1:HC 2 BOX 2069
Mailing Address - Street 2:
Mailing Address - City:WAPPAPELLO
Mailing Address - State:MO
Mailing Address - Zip Code:63966-9508
Mailing Address - Country:US
Mailing Address - Phone:573-222-9811
Mailing Address - Fax:573-222-8212
Practice Address - Street 1:HC 2 BOX 2069
Practice Address - Street 2:
Practice Address - City:WAPPAPELLO
Practice Address - State:MO
Practice Address - Zip Code:63966-9508
Practice Address - Country:US
Practice Address - Phone:573-222-9811
Practice Address - Fax:573-222-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care