Provider Demographics
NPI:1871639807
Name:LAKEPOINT AT CRESTVIEW
Entity Type:Organization
Organization Name:LAKEPOINT AT CRESTVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:316-733-8100
Mailing Address - Street 1:600 N 127TH ST E
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2830
Mailing Address - Country:US
Mailing Address - Phone:316-733-8100
Mailing Address - Fax:316-733-8033
Practice Address - Street 1:600 N 127TH ST E
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2830
Practice Address - Country:US
Practice Address - Phone:316-733-8100
Practice Address - Fax:316-733-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087059310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility