Provider Demographics
NPI:1891305223
Name:LAKE CROSSING HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:LAKE CROSSING HEALTH CENTER, LLC
Other - Org Name:LAKE CROSSING HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-541-0462
Mailing Address - Street 1:6698 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-4120
Mailing Address - Country:US
Mailing Address - Phone:706-541-0462
Mailing Address - Fax:706-541-0310
Practice Address - Street 1:6698 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:APPLING
Practice Address - State:GA
Practice Address - Zip Code:30802-4120
Practice Address - Country:US
Practice Address - Phone:706-541-0462
Practice Address - Fax:706-541-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility