Provider Demographics
NPI:1760797021
Name:LAKEVIEW RETIREMENT RESIDENCE, INC.
Entity Type:Organization
Organization Name:LAKEVIEW RETIREMENT RESIDENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-709-2092
Mailing Address - Street 1:2304 NW 52ND CT
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2681
Mailing Address - Country:US
Mailing Address - Phone:954-714-0064
Mailing Address - Fax:954-714-6033
Practice Address - Street 1:2304 NW 52ND CT
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33309-2681
Practice Address - Country:US
Practice Address - Phone:954-714-0064
Practice Address - Fax:954-714-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9618310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142007100Medicaid