Provider Demographics
NPI:1285638155
Name:LAKEWOOD QUARTERS REHAB 8225 TENANT, LLC
Entity Type:Organization
Organization Name:LAKEWOOD QUARTERS REHAB 8225 TENANT, LLC
Other - Org Name:LAKEWOOD QUARTERS NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-390-4363
Mailing Address - Street 1:8225 SUMMA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3422
Mailing Address - Country:US
Mailing Address - Phone:225-766-6130
Mailing Address - Fax:
Practice Address - Street 1:8225 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3422
Practice Address - Country:US
Practice Address - Phone:225-766-0130
Practice Address - Fax:225-766-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA726314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521043Medicaid
LA1521043Medicaid