Provider Demographics
NPI:1457001737
Name:LAKEVIEW MANOR NURSING AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:LAKEVIEW MANOR NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-590-0007
Mailing Address - Street 1:145 N HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3715
Mailing Address - Country:US
Mailing Address - Phone:318-590-0007
Mailing Address - Fax:
Practice Address - Street 1:400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2623
Practice Address - Country:US
Practice Address - Phone:318-590-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1515442Medicaid