Provider Demographics
NPI:1669467502
Name:LAKEVIEW HEALTH CENTER
Entity Type:Organization
Organization Name:LAKEVIEW HEALTH CENTER
Other - Org Name:LA CROSSE COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACHECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-612-0640
Mailing Address - Street 1:962 GARLAND ST E
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1308
Mailing Address - Country:US
Mailing Address - Phone:608-786-1400
Mailing Address - Fax:608-793-6505
Practice Address - Street 1:962 GARLAND ST E
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1308
Practice Address - Country:US
Practice Address - Phone:608-786-1400
Practice Address - Fax:608-793-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2395313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20160400Medicaid