Provider Demographics
NPI:1821114588
Name:LAKE VIEW HOME I, II, & III
Entity Type:Organization
Organization Name:LAKE VIEW HOME I, II, & III
Other - Org Name:LAKEVIEW HOME ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-727-4993
Mailing Address - Street 1:3431 W 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1632
Mailing Address - Country:US
Mailing Address - Phone:907-333-8921
Mailing Address - Fax:907-677-0344
Practice Address - Street 1:3431 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-1632
Practice Address - Country:US
Practice Address - Phone:907-333-8921
Practice Address - Fax:907-677-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000235 000175 100495310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility