Provider Demographics
NPI:1447733480
Name:CHC LAKESIDE NURSING CENTER, LLC
Entity Type:Organization
Organization Name:CHC LAKESIDE NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-347-0001
Mailing Address - Street 1:305 HIGHWAY 64 E STE D
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-5158
Mailing Address - Country:US
Mailing Address - Phone:870-347-0001
Mailing Address - Fax:
Practice Address - Street 1:1207 WILLOW RUN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:AR
Practice Address - Zip Code:72437-9520
Practice Address - Country:US
Practice Address - Phone:870-237-8151
Practice Address - Fax:870-237-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility