Provider Demographics
NPI:1578678660
Name:LAKE AREA MANAGEMENT GROUP
Entity Type:Organization
Organization Name:LAKE AREA MANAGEMENT GROUP
Other - Org Name:LAKE AREA THERAPY & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-327-8825
Mailing Address - Street 1:1442 KINGWOOD DR PMB 73
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3040
Mailing Address - Country:US
Mailing Address - Phone:281-354-1234
Mailing Address - Fax:281-354-2514
Practice Address - Street 1:400 BYPASS LN STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-7380
Practice Address - Country:US
Practice Address - Phone:936-327-8825
Practice Address - Fax:936-328-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038JCOtherBC/BS OF TEXAS
TXP00190698OtherRAILROAD MEDICARE
TXP00190698OtherRAILROAD MEDICARE