Provider Demographics
NPI:1477036937
Name:LAKECREST CARE LLC
Entity Type:Organization
Organization Name:LAKECREST CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLAJUMOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-454-1952
Mailing Address - Street 1:24523 FOREST CANOPY DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1886
Mailing Address - Country:US
Mailing Address - Phone:973-454-1952
Mailing Address - Fax:
Practice Address - Street 1:24523 FOREST CANOPY DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1886
Practice Address - Country:US
Practice Address - Phone:973-454-1952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)