Provider Demographics
NPI:1821118340
Name:LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Entity Type:Organization
Organization Name:LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Other - Org Name:LAKEVIEW SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-973-9700
Mailing Address - Street 1:1701 SHARP RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-5214
Mailing Address - Country:US
Mailing Address - Phone:262-534-7297
Mailing Address - Fax:262-534-8540
Practice Address - Street 1:1701 SHARP RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-5214
Practice Address - Country:US
Practice Address - Phone:262-534-7297
Practice Address - Fax:262-534-8540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8222-042333600000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11022100Medicaid
WI11022100Medicaid