Provider Demographics
NPI:1639116098
Name:LAKEVIEW NURSING HOME INC
Entity Type:Organization
Organization Name:LAKEVIEW NURSING HOME INC
Other - Org Name:TIMBERLAKE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-368-3103
Mailing Address - Street 1:1155 STERLINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-3811
Mailing Address - Country:US
Mailing Address - Phone:318-368-3103
Mailing Address - Fax:318-368-7471
Practice Address - Street 1:1155 STERLINGTON HWY
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-3811
Practice Address - Country:US
Practice Address - Phone:318-368-3103
Practice Address - Fax:318-368-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA836314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1551459Medicaid
LA195459Medicare ID - Type UnspecifiedPROVIDER NUMBER