Provider Demographics
NPI:1497244693
Name:LAKE LAGOS CARE LLC
Entity Type:Organization
Organization Name:LAKE LAGOS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:KNAVEL ISOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-383-4776
Mailing Address - Street 1:1416 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-2252
Mailing Address - Country:US
Mailing Address - Phone:469-383-4776
Mailing Address - Fax:214-723-5928
Practice Address - Street 1:1416 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-2252
Practice Address - Country:US
Practice Address - Phone:469-383-4776
Practice Address - Fax:214-723-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle