Provider Demographics
NPI:1528008315
Name:LAKE AREA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:LAKE AREA HOME HEALTH, LLC
Other - Org Name:CHOICE HEALTH AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF GROWTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:903-932-1852
Mailing Address - Street 1:715 DISCOVERY BLVD STE 511
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2293
Mailing Address - Country:US
Mailing Address - Phone:512-329-8622
Mailing Address - Fax:512-329-8662
Practice Address - Street 1:401 ISOM RD STE 140C
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2710
Practice Address - Country:US
Practice Address - Phone:210-403-0901
Practice Address - Fax:210-403-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX013043251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1786451Medicaid
TX457986Medicare ID - Type UnspecifiedPROVIDER NUMBER