Provider Demographics
NPI:1609038728
Name:LAKEPOINT CARRIAGE HOUSE
Entity Type:Organization
Organization Name:LAKEPOINT CARRIAGE HOUSE
Other - Org Name:WICHITA HEALTH SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAVALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-943-1294
Mailing Address - Street 1:1325 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1364
Mailing Address - Country:US
Mailing Address - Phone:316-943-1039
Mailing Address - Fax:316-943-8190
Practice Address - Street 1:1325 N WEST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1364
Practice Address - Country:US
Practice Address - Phone:316-943-1039
Practice Address - Fax:316-943-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087049251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100429630AMedicaid