Provider Demographics
NPI:1508042961
Name:LAKEVIEW HEALTHCARE SYSTEMS WATERFORD
Entity Type:Organization
Organization Name:LAKEVIEW HEALTHCARE SYSTEMS WATERFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-973-9700
Mailing Address - Street 1:2011 RUTLAND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5421
Mailing Address - Country:US
Mailing Address - Phone:512-973-9700
Mailing Address - Fax:512-857-0504
Practice Address - Street 1:5310 BUENA PARK RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-2907
Practice Address - Country:US
Practice Address - Phone:262-534-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherZURICH INSURANCE