Provider Demographics
NPI:1609158187
Name:LAKE JACKSON OPERATIONS, LLC
Entity Type:Organization
Organization Name:LAKE JACKSON OPERATIONS, LLC
Other - Org Name:ELMCROFT OF LAKE JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:502-753-6004
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-753-6004
Mailing Address - Fax:502-753-6104
Practice Address - Street 1:206 OAK DR S
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5782
Practice Address - Country:US
Practice Address - Phone:979-297-5577
Practice Address - Fax:979-297-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility