Provider Demographics
NPI:1487644464
Name:LAKEVIEW CHRISTIAN HOME OF THE SOUTHWEST, INC.
Entity Type:Organization
Organization Name:LAKEVIEW CHRISTIAN HOME OF THE SOUTHWEST, INC.
Other - Org Name:LAKEVIEW CHRISTIAN HOSPICE & HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-887-3947
Mailing Address - Street 1:1905 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4025
Mailing Address - Country:US
Mailing Address - Phone:505-887-3947
Mailing Address - Fax:505-234-1905
Practice Address - Street 1:1300 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4600
Practice Address - Country:US
Practice Address - Phone:505-887-3947
Practice Address - Fax:505-234-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6567251E00000X
NM3000251G00000X
NM5088251J00000X, 314000000X
NM5553310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB5046Medicaid
NMI0381Medicaid
NMN3177Medicaid
NMN3177Medicaid
NM32-5087Medicare Oscar/Certification
NMB5046Medicaid