Provider Demographics
NPI:1629593587
Name:LAKEWOOD ASSISTED LIVING
Entity Type:Organization
Organization Name:LAKEWOOD ASSISTED LIVING
Other - Org Name:LAKEWOOD ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:ASSISTED LIVING LIC
Authorized Official - Phone:469-733-3261
Mailing Address - Street 1:6424 FM 2965
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169-8618
Mailing Address - Country:US
Mailing Address - Phone:469-733-3261
Mailing Address - Fax:
Practice Address - Street 1:6424 FM 2965
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-8618
Practice Address - Country:US
Practice Address - Phone:469-733-3261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106844310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility