Provider Demographics
NPI:1508309352
Name:LAKEVIEW HEALTH CARE OPERATIONS
Entity Type:Organization
Organization Name:LAKEVIEW HEALTH CARE OPERATIONS
Other - Org Name:LAKE VIEW HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORRELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-744-9184
Mailing Address - Street 1:73 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:IA
Mailing Address - Zip Code:51450-7312
Mailing Address - Country:US
Mailing Address - Phone:712-657-8527
Mailing Address - Fax:712-657-8618
Practice Address - Street 1:73 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:IA
Practice Address - Zip Code:51450-7312
Practice Address - Country:US
Practice Address - Phone:712-657-8527
Practice Address - Fax:712-657-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165499Medicare Oscar/Certification