Provider Demographics
NPI:1528386091
Name:LAKEWOOD HOSPITAL LLC
Entity Type:Organization
Organization Name:LAKEWOOD HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:OLATOKUNBO
Authorized Official - Middle Name:IFAYEMI
Authorized Official - Last Name:ODUTAYO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-859-3932
Mailing Address - Street 1:8800 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2707
Mailing Address - Country:US
Mailing Address - Phone:713-661-0001
Mailing Address - Fax:713-669-4862
Practice Address - Street 1:1001 DICKERSON DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5110
Practice Address - Country:US
Practice Address - Phone:713-661-0001
Practice Address - Fax:713-669-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK 6196282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural